A Case of selective anaphylaxis to aceclofenac and diclofenac

초록

The pathogenic mechanism of cyclooxygenase(COX)-1 inhibition in NSAIDs hypersensitivity results in multiple cross-reactive intolerance to aspirin and various NSAIDs. However, selective reaction to single NSAID resembling type I hypersensitivity have been sporadically reported. Aceclofenac and diclofenac are widely used NSAID derivative of phenylacetic acid. Selective hypersensitivity reaction to aceclofenac has been rarely reported, and there is no case report of cross-reaction between aceclofenac and diclofenac. A 61-year-old woman taking amlodipine (5mg) and low dose aspirin (100mg) daily for hypertension, piroxicam intermittently for arthralgia developed selective anaphylactic reaction to these two NSAIDs. The first episode was occurred after IM injection of diclofenac sodium (Unipenak, 75 mg) at private clinic. Five minutes after she experienced dyspnea, whole body rashes, hand and lip swelling, and loss of consciousness. After immediate injection of systemic corticosteroids and antihistamine, she was transferred to our hospital and her condition was improved with fluid and oxygen therapy. One month later, the second episode was developed immediately after taking oral aceclofenac tablet (Acetab, 100mg). On hospital arrival, her blood pressure was 72/55 mmHg, and emergent treatments were performed for severe anaphylactic reaction. Skin prick test with aceclofenac, diclofenac, aspirin and other NSAIDs were performed, and the result was positive only to diclofenac. Intradermal test with diclofenac revealed positive reaction, and subsequently she complained of hand and lip swelling, urticarial rashes and chest discomfort. Oral provocation test with aspirin and other NSAIDs showed no specific response. This case suggests an IgE-mediated mechanism of selective phenylacetic acid hypersensitivity by clinical history and skin tests.