อุบัติการณ์และปัจจัยเสี่ยงต่อการเกิดปฏิกิริยา Anaphylactoid จาก N-Acetylcysteine  ในผู้ป่วยพิษเห็ด: การศึกษาย้อนหลังแบบเปรียบเทียบกลุ่มผู้ป่วย: Incidence and Risk Factors Associated with N-Acetylcysteine-Induced Anaphylactoid Reactions in Mushroom Poisoning Patients: A Retrospective Case-Comparison Study

parinya noppakao

Authors

parinya noppakao doctor

Keywords:

พิษเห็ด, N-acetylcysteine, Anaphylactoid, อุบัติการณ์, ปัจจัยที่เกี่ยวข้อง, Mushroom poisoning, anaphylactoid reaction, incidence, associated factors

Abstract

Background: Anaphylactoid reactions to intravenous N-acetylcysteine (NAC) are recognized complications in mushroom poisoning treatment; however, data on incidence and associated factors in this context are lacking in Thailand.

Objective: To determine the incidence of anaphylactoid reactions to IV NAC in mushroom poisoning patients and to compare associated factors between those who developed and those who did not develop anaphylactoid reactions.

Methods: A retrospective descriptive study with case-comparison was conducted by reviewing medical records of mushroom poisoning patients receiving IV NAC at Amnat Charoen Hospital from October 2022 to September 2025. Patients were classified into Group A (anaphylactoid) and Group B (non-anaphylactoid) based on documented clinical records using Brown's criteria (2004). Fisher's Exact Test and Mann-Whitney U test were used for categorical and continuous variables respectively. Incidence was reported with 95% Confidence Interval using Wilson score method.

Results: Forty-three patients met inclusion criteria; 29 were female (67.4%) with a median age of 61 years (IQR 51–69). Most presented during the rainy season (88.4%). Anaphylactoid reactions occurred in 4 patients, yielding an incidence of 9.3% (95% CI: 3.7–21.6). All reactions occurred during the first bag infusion, presented as cutaneous manifestations (urticaria, flushing), and were classified as Mild severity by Brown's grading scale. All patients were successfully restarted on NAC at a slower rate with no deaths, acute kidney injury, or acute liver failure. No statistically significant differences were found in any variables between groups (p > 0.05 for all).

Conclusion: Approximately 1 in 11 mushroom poisoning patients receiving IV NAC developed anaphylactoid reactions, all of which were mild and manageable. Close monitoring during the first bag infusion is essential. Larger multi-center prospective studies are needed to confirm incidence and identify associated factors in this specific context.

Keywords: Mushroom poisoning, N-acetylcysteine, anaphylactoid reaction, incidence, associated factors

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