Abstract
We report two cases of vasospastic angina associated with anaphylactic reaction caused by nonsteroidal antiinflammatory drugs (NSAIDs). Both patients exhibited anaphylactic manifestations, such as general rash and urticaria, along with angina pectoris with electrocardiographic ST‐segment elevations after suppository administration of diclofenac sodium or indomethacin, the most commonly used NSAIDs. Although these patients had normal coronary arteriograms, intracoronary administration of ergonovine or acetylcholine provoked diffuse coronary artery spasms accompanied by chest pain and ischemic ST‐segment changes. It is therefore suggested that an allergic mechanism may be involved as a causative factor of the coronary artery spasm induced by NSAIDs.
Keywords: vasospastic angina, anaphylactic reaction, diclofenac sodium, indomethacin
Full Text
The Full Text of this article is available as a PDF (617.9 KB).
References
- 1. Biscarini L: Anti‐inflammatory analgesics and drugs used in gout In Meyler's Side Effects of Drugs (Ed. Dukes MNG.), p. 181–188. New York: Elsevier, 1992. [Google Scholar]
- 2. Forman MB, Oates JA, Robertson D, Jackson Roberts L II, Virmani R: Increased adventitial mast cells in a patient with coronary spasm. N Engl J Med 1985; 313: 1138–1141 [DOI] [PubMed] [Google Scholar]
- 3. Ginsburg R, Bristow MR, Kantrowitz N, Braim DS, Harrison DC: Histamine provocation of clinical coronary artery spasm: Implications concerning pathogenesis of variant angina pectoris. Am Heart J 1981; 102: 819–822 [DOI] [PubMed] [Google Scholar]
- 4. McFadden EP, Clarke JG, Davies GJ, Kaski JC, Haider AW, Maseri A: Effect of intracoronary serotonin on coronary vessels in patients with stable angina and patients with variant angina. N Engl J Med 1991; 324: 648–654 [DOI] [PubMed] [Google Scholar]
- 5. Egashira K, Origuchi H, Sagara T, Kikuchi Y: Coronary artery spasm during hydrocortisone‐induced allergic reactions. Am Heart J 1987; 113: 1516–1517 [DOI] [PubMed] [Google Scholar]
- 6. Druck MN, Johnstone DE, Staniloff H, McLaughlin PR: Coronary artery spasm as a manifestation of anaphylactoid reaction to iodinated contrast material. Can Med Assoc J 1981; 125: 1133–1135 [PMC free article] [PubMed] [Google Scholar]