Some studies have shown that slowing the infusion rate of the loading dose of N-acetylcysteine has decreased the rate of anaphylactoid reactions. By what mechanism does acetaminophen decrease the incidence of anaphylactoid reaction?
Unlike anaphylaxis, anaphylactoid reactions are non-IgE mediated reactions driven by histamine release from mast cells and mononucleocytes. Acetaminophen’s ability to inhibit histamine release from mast cells decreases the incidence of anaphylactoid reactions with N-acetylcysteine administration at higher APAP serum concentrations.
Coulson J, Thompson JP. Paracetamol (acetaminophen) attenuates in vitro mast cell and peripheral blood mononucleocyte cell histamine release induced by N-acetylcysteine. Clin Toxicol (Phila). 2010;48:111–114
Contributed by: Oyeyimika Oyekanmi, DO On behalf of the VCU Medical Toxicology Fellowship