Acetyl Salicylic Acid Challenge in Children with Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs Differentiates Between Cross-Intolerant and Selective Responders

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

“…In a recent study, an initial OPT with aspirin was performed for all children and adolescents with a history of suspected NSAID‐H reaction, followed by an OPT with the culprit drug, whenever the previous test was negative. By doing that, patients with ASA‐H were only tested once and directly defined as cross‐intolerant . While the authors highlight that this approach may be considered as safe and less time‐consuming, nevertheless, the use of aspirin might be a matter of concern in children due to different clinical conditions like Reye syndrome, and such approach should be discussed for each individual patient.…”

“…36 Therefore, performing an extra OPT with a non-selective COX inhibitor such as ibuprofen in children with a confirmed NSAID-H may be necessary to define the actual cross-intolerance and to search for a safe alternative drug. The initial approach may differ in some particular situations and must be de- 92 and directly defined as cross-intolerant. 93 While the authors highlight that this approach may be considered as safe and less time-consuming, nevertheless, the use of aspirin might be a matter of concern in children due to different clinical conditions like Reye syndrome, and such approach should be discussed for each individual patient.…”

Diagnosis of drug causality in non-immediate drug hypersensitivity in children

“…They are generally divided in cross-intolerant and noncross-intolerant reactions [34]. The most frequent non-immediate reactions in children are cross-intolerant reactions involving angioedema and/or urticaria [35][36][37], which can occur up to 24 hours after drug intake [37]. On the other hand, mild exanthemas after NSAID therapy are not as common, representing 14-23% of children in studies [37,38].…”

“…The most frequent non-immediate reactions in children are cross-intolerant reactions involving angioedema and/or urticaria [35][36][37], which can occur up to 24 hours after drug intake [37]. On the other hand, mild exanthemas after NSAID therapy are not as common, representing 14-23% of children in studies [37,38]. STs to NSAIDS are not validated [37,39], and DPTs are the gold standard to determine NSAID tolerance or selective responders, and/or to eliminate crossintolerance reactions.…”

“…On the other hand, mild exanthemas after NSAID therapy are not as common, representing 14-23% of children in studies [37,38]. STs to NSAIDS are not validated [37,39], and DPTs are the gold standard to determine NSAID tolerance or selective responders, and/or to eliminate crossintolerance reactions. Most children with a history of mild exanthematous reactions to NSAIDs on history have negative DPTs [37,38,40,41] and studies have shown that patients with a history of reaction after 1 h of drug intake are less at risk of reacting on DPT [36,37].…”