Anaphylactic reaction after intravenous dipyrone

Stamer, Ulrike M.; Soehle, Martin; Park, Tjoung-Won; Fischer, Matthias; Stuber, Frank

doi:10.1016/j.acpain.2007.08.025

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Volume 9, Issue 4 , Pages 221-227, December 2007

Anaphylactic reaction after intravenous dipyrone

Ulrike M. Stamer
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
- Corresponding author. Tel.: +49 228 287 14114; fax: +49 228 287 14125.
Martin Soehle
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
Tjoung-Won Park
- Department of Obstetrics and Gynaecology, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
Matthias Fischer
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Klinik am Eichert, 73006 Göppingen, Germany
Frank Stuber
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany

Received 27 April 2007; received in revised form 27 July 2007; accepted 16 August 2007.

Summary

Dipyrone (metamizol), a non-opioid analgesic, is widely used for acute and chronic pain management. Although not marketed in all countries because of concerns of possible side effects like agranulocytosis, this potent analgesic is frequently used worldwide.

A severe anaphylactic reaction without any cutaneous symptoms was observed after intravenous infusion of dipyrone 1g. Further symptoms were a short lasting increase in airway pressure and a pronounced generalized oedema. Circulatory arrest required cardiopulmonary resuscitation. Pre-existing β-blockade aggravated poor response to adrenaline. Recovery of the patient was uneventful.

Previous case reports demonstrated that symptoms of allergic reaction after dipyrone might vary considerably. Erythema, bronchospasm and eyelid-/angio-oedema might present alone or in combination. Sole cardiovascular collapse produced by extreme generalized oedema and consecutive hypotension occurred after i.v. administration during anaesthesia. Risk factors for severe dipyrone induced allergy are: allergies/intolerability of dipyrone and other non-opioids and bronchial asthma. However, allergic reaction after previous intake of dipyrone without side effects has been described.

Keywords: Dipyrone (metamizol), Anaphylaxis, Oedema, Postoperative analgesia, Cardiopulmonary resuscitation, β-Blockade