Drug Provocation Tests in the Diagnosis of Hypersensitivity Reactions to Non-Steroidal Anti-Inflamatory Drugs in Children

Abstract

RationaleHypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent reported reactions. They can be induced by pharmacological mechanism (cyclooxigenase inhibition), being patients classified as cross-intolerance (CI), and by specific immunological mechanisms (IgE or T cell), being considered as selective reactors (SR). The aim of the study was to analyse a large group of children with a history of NSAID hypersensitivity that were diagnosed by drug provocation test (DPT).MethodsSixty three children with a history of NSAIDs hypersensitivity were evaluated by DPT. Patients were classified as CI or SR depending on the acetyl salicylic acid response. The atopic status was assessed by prick tests to a standard of common inhalant allergens and total IgE in serum.ResultsThe 68.2% were confirmed as having hypersensitivity, and from this 58.1% classified as CI and 41.9% as SR. From a total of 119 DPT performed, 73 were positive (53.4% positive to Ibuprofen, 37% to AAS, 8.2% to metamizol and 1.4 to paracetamol), being angioedema the clinical symptoms presented in 86.3% of cases alone or accompanied with urticaria. All CI cases tolerated the administration of paracetamol. There was a significant number of atopic subjects in those with CI (72%) compared with those with SR (27.7%) and non-allergic controls (30%).ConclusionsIn children CI hypersensitivity to NSAID is more frequent reaction, being ibuprofen the drug most often involved, the most common entity was angioedema, being atopy frequently associated. DPT resulted to be a safe approach for diagnosing these patients. RationaleHypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent reported reactions. They can be induced by pharmacological mechanism (cyclooxigenase inhibition), being patients classified as cross-intolerance (CI), and by specific immunological mechanisms (IgE or T cell), being considered as selective reactors (SR). The aim of the study was to analyse a large group of children with a history of NSAID hypersensitivity that were diagnosed by drug provocation test (DPT). Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent reported reactions. They can be induced by pharmacological mechanism (cyclooxigenase inhibition), being patients classified as cross-intolerance (CI), and by specific immunological mechanisms (IgE or T cell), being considered as selective reactors (SR). The aim of the study was to analyse a large group of children with a history of NSAID hypersensitivity that were diagnosed by drug provocation test (DPT). MethodsSixty three children with a history of NSAIDs hypersensitivity were evaluated by DPT. Patients were classified as CI or SR depending on the acetyl salicylic acid response. The atopic status was assessed by prick tests to a standard of common inhalant allergens and total IgE in serum. Sixty three children with a history of NSAIDs hypersensitivity were evaluated by DPT. Patients were classified as CI or SR depending on the acetyl salicylic acid response. The atopic status was assessed by prick tests to a standard of common inhalant allergens and total IgE in serum. ResultsThe 68.2% were confirmed as having hypersensitivity, and from this 58.1% classified as CI and 41.9% as SR. From a total of 119 DPT performed, 73 were positive (53.4% positive to Ibuprofen, 37% to AAS, 8.2% to metamizol and 1.4 to paracetamol), being angioedema the clinical symptoms presented in 86.3% of cases alone or accompanied with urticaria. All CI cases tolerated the administration of paracetamol. There was a significant number of atopic subjects in those with CI (72%) compared with those with SR (27.7%) and non-allergic controls (30%). The 68.2% were confirmed as having hypersensitivity, and from this 58.1% classified as CI and 41.9% as SR. From a total of 119 DPT performed, 73 were positive (53.4% positive to Ibuprofen, 37% to AAS, 8.2% to metamizol and 1.4 to paracetamol), being angioedema the clinical symptoms presented in 86.3% of cases alone or accompanied with urticaria. All CI cases tolerated the administration of paracetamol. There was a significant number of atopic subjects in those with CI (72%) compared with those with SR (27.7%) and non-allergic controls (30%). ConclusionsIn children CI hypersensitivity to NSAID is more frequent reaction, being ibuprofen the drug most often involved, the most common entity was angioedema, being atopy frequently associated. DPT resulted to be a safe approach for diagnosing these patients. In children CI hypersensitivity to NSAID is more frequent reaction, being ibuprofen the drug most often involved, the most common entity was angioedema, being atopy frequently associated. DPT resulted to be a safe approach for diagnosing these patients.