Drug hypersensitivity salicylates

The keratolytics are contraindicated in patients with known hypersensitivity to the drugs and for use on moles, birthmarks, or warts with hair growing from them, on genital or facial warts, on warts on mucous membranes, or on infected skin. Prolonged use of the keratolytics in infants or patients with diabetes or impaired circulation is contraindicated. Salicylic acid... 

Hypersensitivity to salicylates or nonsteroidal anti-inflammatory drugs (NSAIDs). Use extreme caution in patients with history of adverse reactions to salicylates. Cross-sensitivity may exist between aspirin and other NSAIDs that inhibit prostaglandin synthesis, and aspirin, and tartrazine. Aspirin cross-sensitivity does not appear to occur with sodium salicylate, salicylamide, or choline salicylate. Aspirin hypersensitivity is more prevalent in those with asthma, nasal polyposis, chronic urticaria. 

Hypersensitivity to sulfonamides or chemically related drugs (eg, sulfonylureas, thiazide and loop diuretics, carbonic anhydrase inhibitors, sunscreens with PABA, local anesthetics) pregnancy at term lactation infants less than 2 months of age (except in congenital toxoplasmosis as adjunct with pyrimethamine) porphyria salicylate hypersensitivity. 

Some patients exhibit hypersensitivity to aspirin in the form of salicylism, which is accompanied by ringing in the ears (tinnitus), vertigo, and bronchospasm (especially in asthmatics). The use of salicylate-containing preparations is not the only source of this drug. Those sensitive to salicylates should be aware of salicylates in a number of foods, such as curry powder, licorice, prunes, raisins, and paprika. 

The arylpropionic acid derivatives are useful for the treatment of rheumatoid arthritis and osteoarthritis, for reduction of mild to moderate pain and fever, and for pain associated with dysmenorrhea. Side effects of the drugs are similar to but less severe than those described for the salicylates. Those who are sensitive to salicylates also may be sensitive to and have adverse reactions when taking ibuprofen and related drugs. Acute hypersensitivity to ibuprofen has been reported in patients with lupus. The hypersensitivity reaction to sulindac can be fatal. The use of sulindac has also been linked to cases of acute pancreatitis. The use of dimethylsulfoxide (DMSO) topically in combination with sulindac has been reported to induce severe neuropathies. The concurrent use of ibuprofen with aspirin reduces the antiinflammatory effects of both drugs. Ibuprofen is contraindicated in patients with aspirin sensitivity leading to bronchiolar constriction and in patients with an-gioedema. As with all NSAIDs, renal and liver function should be normal for adequate clearance of the drugs. 

Sulfasalazine is contraindicated in individuals with hypersensitivity to salicylates, sulfonamides, sulfonylureas, and certain diuretics (furosemide, thiazides, and carbonic anhydrase inhibitors). Because it can cause kernicterus, sulfasalazine is contraindicated in infants and children under 2 years of age. Sulfasalazine passes into breast milk and is therefore contraindicated for nursing mothers. Similarly, pregnant women near term should not use this drug, although it appears to be the safest of the DMARDs during early pregnancy. 

Drug interactions May decrease antihypertensive effects of ACE inhibitors, angiotensin II antagonists. May decrease antihypertensive and diuretic effects of thiazide and loop diuretics May decrease absorption of vitamin B,2 Effects decreased by barbiturates, phenytoin, and rifampin decreases effect of salicylates and vaccines Decreases clearance of beta-lactams Risk for hypersensitivity increased in patients who are on thiazides or ACE inhibitors and allopurinol... 

Acetaminophen usually is well tolerated at recommended therapeutic doses. Rash and other allergic reactions occur occasionally. The rash usually is erythematous or urticarial, but sometimes it is more serious and may be accompanied by drug fever and mucosal lesions. Patients who show hypersensitivity reactions to the salicylates only rarely exhibit sensitivity to acetaminophen. The use of acetaminophen has been associated anecdotally with neutropenia, thrombocytopenia, and pancytopenia. 

Acetaminophen usually is well tolerated. Erythematous or urticarial rash may occur and may be accompanied by drug fever and mucosal lesions. Patients who show hypersensitivity reactions to the salicylates only rarely exhibit sensitivity to acetaminophen. 

The salicylates are contraindicated in patients with known hypersensitivity to the salicylates or the NSAIDs and during pr nancy. Aspirin is a Piregnancy Cat ory D drug and may produce adverse maternal effects (ie, anemia, postpartum hemorrhagi and prolonged gestation or labor). Maternal aspirin used may... 

Sulfasalazine is used for the treatment of mild to moderate ulcerative colitis as adjunct therapy in the treatment of severe ulcerative colitis, for the treatment of Crohn s disease, and for the treatment of rheumatoid arthritis or ankylosing spondylitis. Contraindications include hypersensitivity to sulfa drugs, salicylates, intestinal or urinary obstruction, and porphyria. 

About 10% of asthmatics are hypersensitive to aspirin, and in some individuals life-threatening bronchoconstriction can occur. This is not a drug-drug interaction but an adverse response of asthmatic patients to aspirin, whether taking an anti-asthmatic drug or not. The reasons are not fully understood. Those known to be sensitive to aspirin may also possibly react to other NSAIDs, in particular the acetylated salicylates, the indole and indene acetic acids, and the propionic acid derivatives (see Table 6.1 , (p.l34)). The fenamates, oxicams, pyrazolones and pyrazolidinediones are better tolerated. The nonacetylated salicylates (sodium salicylate, salicylamide, choline magnesium trisalicylate) are normally well tolerated. Aspirin-sensitive individuals are also less likely to react to nimesulide. ... 

Tartrazine is most likely to produce urticaria in patients with allergic hypersensitivity to aspirin and the salicylate drugs (Ros et al. 1976). It is, therefore, prudent to administer white antihistamines, free of dyes, to such aspirin-sensitive individuals. (The presence of color in a tablet or capsule does not necessarily imply that the F.D. and C. Yellow No. 5 is necessarily used in its manufacture, however, a white antihistamine is free of all dyes.) The antihistamines shown in Table 2 are free of all dyes. 

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