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

Abstract

Background: 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.

Follow-up: 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.

Conclusions: 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.

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