Doctors have highlighted a unique case of possible anaphylaxis to two structurally dissimilar NSAIDs in a 45-year-old woman who was exposed to ibuprofen and aspirin, despite no history of allergic reactions or adverse events.

The otherwise healthy patient was referred to allergy and immunologist specialists from ED, where she received IM adrenaline after developing acute-onset dyspnoea, swelling lips and generalised urticaria in response to ibuprofen.

She had previously tolerated ibuprofen, naproxen and paracetamol and had no history or urticaria, angioedema, asthma, nasal polyps, or any other identifiable cofactors, her doctors said.

They were able to reproduce her symptoms after a graded drug provocation test (DPT), during which she developed diffuse urticaria shortly after her final dose of ibuprofen (cumulative 200mg).