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Indian Journal of Medical Sciences, Vol. 62, No. 12, December, 2008, pp. 499 Letter To Editor Authors' reply Panchabhai TanmayS, Gogtay NithyaJ, Bavdekar SandeepB Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai Code Number: ms08092 Sir, We are grateful to Dr. Oshikoya for his interest [1] in our report of a case of paracetamol angioedema. [2] We offer the following responses: We agree that viral infection could be a possible cause for angioedema in children. However, as detailed in the case report, the morphological characteristics of the initial rash and the rash that developed following the exposure to paracetamol were different, suggesting separate etiologies. More importantly, the attack of angioedema was not an isolated one. The child developed angioedema (day 3) which did not subside through days 4 and 5, when the child continued to receive paracetamol from his general practitioner. The child was admitted to our facility on day 5. A thorough past medical history did not reveal any past history of angioedema. The fact that angioedema subsided as soon as administration of paracetamol was suspended supports our conclusion of a probable adverse reaction. We would like to point out that the initial rash that the child had developed due to a presumed viral infection subsided four days after the angioedema, again pointing to a possible role of paracetamol in this adverse reaction. We agree that a supervised oral challenge test is the definitive means of diagnosing paracetamol-induced angioedema. This test, however, could not be performed as parents refused permission. Paracetamol is readily available in India in packaged formulations and hence storage at home resulting in increased toxicity and adverse reactions is unlikely though possible. By eliciting a discussion, we seem to have succeeded in our objective of creating and increasing awareness amongst general practitioners about the possibility of adverse reactions with paracetamol, which is known to have an excellent safety record. References
Copyright 2008 - Indian Journal of Medical Sciences |
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