A Case Series of Eight Patients with Clinical Anaphylaxis in the Setting of Vincristine Administration

Abstract

RATIONALE: Drug provocation test (DPT) is the gold standard to diagnose analgesic drugs hypersensitivity reactions (HRs). The purpose of this study was to confirm the diagnosis in patients with NSAIDs and acetaminophen HRs and to find the safe alternatives. METHODS: This is a retrospective study which enrolled adult participants with history of NSAIDs and acetaminophen-induced immediate drug HRs whose skin prick test results were negative. Their DPTs were singleblinded and placebo controlled. The analgesic drugs included acetaminophen, NSAIDs (aspirin, ibuprofen, diclofenac, mefenamic acid, and meloxicam), COX-2 inhibitor (etoricoxib) and tramadol. All participants were challenged with placebo and the analgesic drugs by ingestion of increasing dose every 60 minutes, started from 25%, 50%, 75% and then 100% of their targeted therapeutic dose. RESULTS: Eighteen participants consented to DPTs. We performed 404 DPTs. Sixty-seven (16.58%) tests were positive with 2 of those were anaphylaxis. DPTs confirmed the diagnosis in all of 5 participants with the history of NSAIDs and acetaminophen HRs and 8 participants with the history of only NSAIDs HRs. DPTs were able to diagnose 50% of 4 participants with the history of acetaminophen HRs. Eleven participants had multiple NSIADs positive results. DPTs with etoricoxib and tramadol were negative in 12 (66.66%) and 14 (77.78%) out of 18 participants, respectively. Six participants with etoricoxib positive DPTs had multiple NSIADs positive DPTs too. CONCLUSIONS: This study indicated the DPT was a good diagnostic test for analgesic drugs HRs. Etoricoxib and tramadol were tolerated in the majority but not all participants tested.