Propacetamol (N,N-diethyl glycidyl ester of acetaminophen) is a soluble bioprecursor of acetaminophen. It is composed of an acetaminophen molecule coupled to a vector: diethylglycine. A very effective and well tolerated analgesic, it is a prodrug widely used for its analgesic and antipyretic properties. Following intravenous injection, propacetamol is readily hydrolized into acetaminophen 2 and N,N-diethylglycine 3).
Several cases of occupational contact dermatitis have been reported in nurses handling propacetamol.
Nurses frequently handling propacetamol (surgery, intensive care units, oncology).
Chronic eczema with vesiculous flares on the back of the hands sometimes extending to wrists, forearms, and occasionally on the face.
Patch-tests with propacetamol are positive ; but negative with solvent, acetaminophen and diethylglycine.
Patch-tests with N,N-diethylglycine phenyl ester (activated form of N,N- diethylglycine) in 10% pet. are positive in patients with contact dermatitis to propacetamol. This strongly suggests that propacetamol acts as an activated form of N,N-diethylglycine, transferring this part of the molecule to nucleophilic residues of proteins. So acetaminophen allergy has never been observed in propacetamol-allergic patients.
The wearing of gloves for preparing propacetamol is mandatory, especially in cases where allergic history enhances the risk of occupational sensitization.