![]() Non-immune reactions may be caused by imbalance in the arachidonic acid pathway. Symptoms include conjunctivitis, rhinitis, bronchospasm, angioedema, hypersensitivity pneumonitis, meningitis, urticaria and anaphylaxis. Immune-mediated reactions are rare and drug-specific. Hypersensitivity to NSAIDs is caused by immunological and non-immunological mechanisms. Currently Celecoxib is the only COX-2 selective inhibitor available in the United States. Most are non-selective such as aspirin, ibuprofen, and acetaminophen. They work by inhibiting the cyclooxygenase enzymes COX-1 and COX-2. NSAIDs (non-steroidal anti-inflammatory drugs) are commonly used for pain and fever relief. They decided to look up the question when they had time later in the day. She also didn’t know how often there was cross-reactivity. The attending physician said that she also didn’t seem to see much of this hypersensitivity but knew that it was relatively common. When discussing the patient with her attending physician, the resident noted that she had not encountered an allergy to ibuprofen before and asked how often there was cross-reactivity with other non-steroidal anti-inflammatory drugs. The diagnosis of acute streptococcal pharyngitis was made. She had exudative pharyngitis and anterior cervical nodes bilaterally that were 0.5-1.0 cm in size. ![]() The pertinent physical exam showed a mildly ill child with normal vital signs and growth parameters. The mother said that she used acetaminophen for pain and fever relief without any problems. When reviewing her medications and allergies, the resident noted that she was allergic to ibuprofen and her mother said that she had problems breathing and an urticarial rash twice after receiving ibuprofen that required her to go to the emergency room. A 5-year-old female came to clinic with a history of acute pharyngitis that was positive for Group A, β-hemolytic Streptococcus.
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