A case of severe NSAID exacerbated respiratory disease (NERD) following a dental procedure in a child
- 334 Downloads
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.
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.
KeywordsAllergy 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.
This case report does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in this case report.