ArticleJournal of medical toxicology : official journal of the American College of Medical Toxicology2018
Anaphylactoid Reactions to Intravenous N-Acetylcysteine during Treatment for Acetaminophen Poisoning.
Article in Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 30 papers, 2 of them syntheses that pooled it.
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Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 57 citations in OpenAlex.
- N-Acetylcysteine for Preventing Acetaminophen-Induced Liver Injury: A Comprehensive Review.Frontiers in pharmacology · 2022Pooled it
- N-Acetylcysteine for Cardiac Protection During Coronary Artery Reperfusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Frontiers in cardiovascular medicine · 2021Pooled it
- Unravelling the Therapeutic Potential of Cysteine for Cardiovascular Health.International journal of molecular sciences · 2026Review
- Von Willebrand Factor as a Therapeutic Target in Thrombotic Disorders.Thrombosis and haemostasis · 2026Review
- Edible Fungus Compound Cordycepin Protects Against Acetaminophen-Induced Liver Injury.Journal of clinical laboratory analysis · 2026Article
- Redefining the role of the thiol-based agentRSC medicinal chemistry · 2026Review
- PLGA nanoparticles encapsulating fibroblast growth factor 21 alleviate acetaminophen-induced acute liver injury.Naunyn-Schmiedeberg's archives of pharmacology · 2026Article
- N-Acetylcysteine Therapy in Thrombotic Thrombocytopenic Purpura: A Systematic Review and Critical Appraisal.Journal of clinical medicine · 2026Review
- A new opportunity for N-acetylcysteine. An outline of its classic antioxidant effects and its pharmacological potential as an epigenetic modulator in liver diseases treatment.Naunyn-Schmiedeberg's archives of pharmacology · 2025Review
- The potential role of N-acetylcysteine as an adjuvant therapy in acute aluminum phosphide poisoning: a randomized clinical trial.Toxicology research · 2025Article
- Gardenia jasminoides extract mitigates acetaminophen-induced liver damage in mice.BMC complementary medicine and therapies · 2024Article
- The protective effect of Thai rice bran on N-acetyl-ρ-aminophen-induced hepatotoxicity in mice.Research in pharmaceutical sciences · 2024Article
- Perioperative N-acetylcysteine: evidence and indications.Pain management · 2024Review
- Repurposing N-acetylcysteine for management of non-acetaminophen induced acute liver failure: an evidence scan from a global health perspective.Translational gastroenterology and hepatology · 2024Article
- MitoNEET Provides Cardioprotection via Reducing Oxidative Damage and Conserving Mitochondrial Function.International journal of molecular sciences · 2023Review
- Advances in the Use ofAntioxidants (Basel, Switzerland) · 2023Review
- Calcitriol Protects against Acetaminophen-Induced Hepatotoxicity in Mice.Biomedicines · 2023Article
- Anaphylactoid reactions induced by Shuanghuanglian injection and Shenmai injection and metabolomics analysis.Frontiers in pharmacology · 2023Article
- Aleppo galls alleviate paracetamol-induced hepatotoxicity and tissue damage: an experimental study.International journal of biochemistry and molecular biology · 2023Article
- Hepatoprotective Effects of Radish (Nutrients · 2022Article
Corrections and comments
- Erratum issued
Authors and funding
12 authors at 8 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAnaphylactoid reactions to intravenous (IV) N-acetylcysteine (NAC) are well-recognized adverse events during treatment for acetaminophen (APAP) poisoning. Uncertainty exists regarding their incidence, severity, risk factors, and management. We sought to determine the incidence, risk factors, and treatment of anaphylactoid reactions to IV NAC in a large, national cohort of patients admitted to hospital for acetaminophen overdose.
methodsThis retrospective medical record review included all patients initiated on the 21-h IV NAC protocol for acetaminophen poisoning in 34 Canadian hospitals between February 1980 and November 2005. The primary outcome was any anaphylactoid reaction, defined as cutaneous (urticaria, pruritus, angioedema) or systemic (hypotension, respiratory symptoms). We examined the incidence, severity and timing of these reactions, and their association with patient and overdose characteristics using multivariable analysis.
resultsAn anaphylactoid reaction was documented in 528 (8.2%) of 6455 treatment courses, of which 398 (75.4%) were cutaneous. Five hundred four (95.4%) reactions occurred during the first 5 h. Of 403 patients administered any medication for these reactions, 371 (92%) received an antihistamine. Being female (adjusted OR 1.24 [95%CI 1.08, 1.42]) and having taken a single, acute overdose (1.24 [95%CI 1.10, 1.39]) were each associated with more severe reactions, whereas higher serum APAP concentrations were associated with fewer reactions (0.79 [95%CI 0.68, 0.92]).
conclusionAnaphylactoid reactions to the 21-h IV NAC protocol were uncommon and involved primarily cutaneous symptoms. While the protective effects of higher APAP concentrations are of interest in understanding the pathophysiology, none of the associations identified are strong enough to substantially alter the threshold for NAC initiation.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.