Anthralinic acid derivatives


Group of NSAIDs including glafenine, antrafenine, floctafenine, and the fenamates (mefenamic acid, flufenamic, etofenamic and meclofenamic acids).
 
Incidence (conflictual)
Glafenine: 1/2000 to 3,4/100 000 courses. 14 cases of allergy requiring hospital admission in the Netherlands in 1981.
 
Antrafenine: 1.3/100 000 treatments.
 
Floctafenine: 0.6/100 000 treatments.
 
Risk factors
Intolerance to other NSAIDs.
 
Clinical manifestations
Anaphylactic shock.
 
Urticaria, angioedema.
 
Bronchospasm.
 
Renal failure, hepatitis, blood dyscrasias.
 
Diagnostic methods

Cutaneous testing.
 
One case of positive intradermal skin test with glafenine 0.1 to 1 mg/ ml and meclofenamate 0.1 to 1 mg/ ml.
 
Leukocyte migration test: positive in 50% of patients with glafenine intolerance.
 
Basophil histamine release: positive in 16% of patients with glafenine intolerance.
 
Double blind placebo-controlled challenge.
 
Mechanisms (uncertain)
IgE-mediated hypersensitivity: one case reported with positive skin tests in a patient specifically allergic to anthralinic derivatives but tolerating aspirin and other NSAIDs.
 
Intolerance: similar mechanisms to other NSAIDs.
 
Management
Avoidance of glafenine and related molecules (withdrawn in numerous countries).
 
Ascertain other NSAID tolerance.

References

  1. Fernandez-Rivas M, de la Hoz B, Cuevas M, Davila I, Quirce S, Losada E, "Hypersensitivity reactions to anthralinic acid derivatives", Ann. Allergy., 1993 ; 71 (6): 515-8
  2. Stricker B.H, de Groot R.R, Wilson J.H, "Glafenine-associated anaphylaxi as a cause of hospital admission in the Netherlands", Eur. J. Clin. Pharmacol., 1991 ; 40 (4): 367-71
  3. Stricker B.H, de Groot R.R, Wilson J.H, "Anaphylaxis to glafenine (letter)", Lancet. 1990 ; 336 (8720): 943-4
  4. Cheymol G, Biour M, Bruneel M, Albengres E, Hamel J.D, "Bilan d’une enquête nationale prospective sur les effets indésirables de la glafenine, de l’antrafenine, et de la floctafenine", Therapie. 1985 ; 40: 45-50

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.