European Archives of Paediatric Dentistry

, Volume 17, Issue 4, pp 277–281 | Cite as

A case of severe NSAID exacerbated respiratory disease (NERD) following a dental procedure in a child

  • G. KingEmail author
  • A. Byrne
  • P. Fleming
Case Report



An allergic reaction following a dental procedure is a rare event. A local anaesthetic (LA) may initially be suspected as a causative agent but allergy to dental LA solutions is extremely rare.

Case report

This report concerns a 13 year old child who underwent dental treatment and was exposed to Lignospan Special® LA, mouthwash, latex gloves, ibuprofen medication, and a Magnum® (almond) ice cream all within 45 min. He subsequently developed acute symptoms of nasal rhinorrhoea, facial flushing, peri-orbital and lip angioedema, followed by throat tightness and wheeze (respiratory compromise). His acute reaction was treated by his medical practitioner with oral anti-histamines, steroid and nebulised salbutamol. The child was referred to a local allergist. The child underwent detailed allergic investigations including skin prick tests, blood tests, incremental local anaesthetic challenge and ibuprofen challenge. The patient was diagnosed with NSAID exacerbated respiratory disease (NERD), a hypersensitivity reaction to ibuprofen.


The patient was advised to avoid NSAIDs and to wear a medic-alert (allergy) bracelet. A detailed written report was sent to the patient’s dentist and GP.


In the context of a suspected reaction post dental procedure, local anaesthetic should be considered a possible allergen but other important considerations include analgesics, antibiotics, and latex. All genuine allergic reactions need to be investigated. This report highlights NERD as a possible adverse outcome following dental treatment.


Allergy Adverse drug reaction Hypersensitivity Local anaesthetic Non-steroidal anti-inflammatory drug (NSAID) NERD 


Compliance with ethical standards


There was no funding received by the authors for this case report.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This case report does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in this case report.


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Copyright information

© European Academy of Paediatric Dentistry 2016

Authors and Affiliations

  1. 1.Our Lady’s Children’s Hospital CrumlinDublin 12Ireland
  2. 2.Dublin Dental University Hospital, Trinity CollegeDublin 2Ireland

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