Fixed drug eruption to nimesulide: an exuberant presentation confirmed by patch testing

Marques, Lidiane Pereira; Villarinho, Ana Luiza Castro Fernandes; Melo, Maria das Graças Mota; Torre, Marília Gabriela Senra

doi:10.1590/abd1806-4841.20187338

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…General recommendations for intradermal and patch testing are shown in several reviews 144,145. In this respect, although no large series of T-cell-mediated reactions to NSAIDs are available there are several studies with different drugs from these groups that show the concentration used for intradermal or patch testing 146–148. In general, patch testing is reserved for those NSAIDs that are not soluble, and powder solutions in petrolatum at a concentration of 5%–20% w/w are recommended although a maximum concentration value in a negative control needs to be assessed with new drugs where information is not available in the literature.…”

Section: Managementmentioning

confidence: 99%

<p>NSAID-induced reactions: classification, prevalence, impact, and management strategies</p>

Blanca‐López¹,

Soriano²,

García‐Martín³

et al. 2019

JAA

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are the leading cause of hypersensitivity drug reactions. The different chemical structures, cyclooxygenase 1 (COX-1) and/or COX-2 inhibitors, are taken at all ages and some can be easily obtained over the counter. Vasoactive inflammatory mediators like histamine and leukotriene metabolites can produce local/systemic effects. Responders can be selective (SR), IgE or T-cell mediated, or cross-intolerant (CI). Inhibition of the COX pathway is the common mechanism in CI, with the skin being the most frequent organ involved, followed by the lung and/or the nose. An important number of cases have skin and respiratory involvement, with systemic manifestations ranging from mild to severe anaphylaxis. Among SR, this is the most frequent entity, often being severe. Recent years have seen an increase in reactions involving the skin, with many cases having urticaria and/or angioedema in the absence of chronic urticaria. Aspirin, the classical drug involved, has now been replaced by other NSAIDs, with ibuprofen being the universal culprit. For CI, no in vivo/in vitro diagnostic methods exist and controlled administration is the only option unless the cases evaluated report repetitive and consistent episodes with different NSAIDs. In SR, skin testing (patch and intradermal) with 24–48 reading can be useful, mainly for delayed T-cell responses. Acetyl salicylic acid (ASA) is the test drug to establish the diagnosis and confirm/exclude CI by controlled administration. Desensitization to ASA has been extensively used in respiratory cases though it can also be applied in those cases where it is required.

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Section: Managementmentioning

confidence: 99%

<p>NSAID-induced reactions: classification, prevalence, impact, and management strategies</p>

Blanca‐López¹,

Soriano²,

García‐Martín³

et al. 2019

JAA

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“…In smaller studies, high rates of positivity to piroxicam (85.7% in one study, 6 of 7 patients) [69] and antibiotics (beta-lactams, fluoroquinolones and sulfonamides) (50%, corresponding to 4 of 8 patients) have also been reported [61]. There are numerous case reports of patch test positivity in the setting of FDE to other drugs, including fluconazole [70][71][72], adalimumab [73], etoricoxib [74][75][76][77][78], piroxicam [69,79,80], nimesulide [81][82][83], and contrast medium [84,85].…”

Section: Fixed Drug Eruption (Fde)mentioning

confidence: 99%

The Role of Patch Testing in Evaluating Delayed Hypersensitivity Reactions to Medications

Woodruff

Botto

2022

Clinic Rev Allerg Immunol

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Confirming drug imputability is an important step in the management of cutaneous adverse drug reactions (CADR). Re-challenge is inconvenient and in many cases life threatening. We review the literature on ideal patch testing technique for specific CADRs. Testing should be performed approximately 3 months after the resolution of the eruption using standard patch testing techniques. Commercially available patch test preparations are available for a minority of drugs, so in most cases, testing should be performed with the drug at various recommended concentrations and in different vehicles. Testing to all known excipients, such as dyes, vehicles and preservatives is also important. Immunosuppressive medications should be discontinued or down titrated to the lowest tolerable dose to decrease the risk of false negative reactions. We provide an overview of expert recommendations and extant evidence on the utility of patch testing for identifying the culprit drug in common CADRs and for specific drug or drug classes. Overall, there appears to be significant variability in the patch test positivity of different drugs, which is likely the result of factors intrinsic to the drug such as dermal absorption (as a function of lipophilicity and molecular size) and whether the drug itself or a downstream metabolite is implicated in the immune reaction. Drugs with high patch test positivity rates include beta-lactam antibiotics, aromatic anticonvulsants, phenytoin, and corticosteroids, among others. Patch testing positivity varies both as a function of the drug and type of CADR. The sum of the evidence suggests that patch testing in the setting of morbilliform eruptions, fixed drug eruption, acute generalized exanthematous pustulosis, and possibly also drug-induced hypersensitivity syndrome, photoallergic and eczematous reactions may be worthwhile, although utility of testing may vary on the specific drug in question for the eruption. It appears to be of limited utility and is not recommended in the setting of other complex CADR, such as SJS/TEN and leukocytoclastic vasculitis.

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Nimesulide

2018

Reactions Weekly

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Fixed drug eruption to nimesulide: an exuberant presentation confirmed by patch testing

Cited by 5 publications

References 4 publications

<p>NSAID-induced reactions: classification, prevalence, impact, and management strategies</p>

<p>NSAID-induced reactions: classification, prevalence, impact, and management strategies</p>

The Role of Patch Testing in Evaluating Delayed Hypersensitivity Reactions to Medications

Nimesulide

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