Atopy is a risk factor for non-steroidal anti-inflammatory drug sensitivity

Sánchez‐Borges, Mario; Capriles‐Hulett, Arnaldo

doi:10.1016/s1081-1206(10)62748-2

Cited by 152 publications

(111 citation statements)

References 28 publications

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“…18 The exact mechanism remains unclear. 15,17 However, this association was not found by other authors. 4,14 In our study, patients with confirmed NSAID-H presented a higher frequency of asthma and rhinitis than patients with excluded NSAID-H.…”

Section: Discussionmentioning

confidence: 65%

Non-steroidal anti-inflammatory drug hypersensitivity in children

Alves

Romeira

Abreu

et al. 2017

Allergologia et Immunopathologia

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Introduction: There are rather few publications about hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAID) in the paediatric age. In this study, we aimed to assess the frequency of confirmed NSAID hypersensitivity in children with a previous reported reaction to NSAID in order to investigate the role of the drug provocation test (DPT) in the diagnostic workup and to explore the factors associated with confirmed NSAID hypersensitivity. Methods: We conducted a retrospective analysis of the clinical files from every patient under 18 years old who attended two Portuguese paediatric allergy outpatient clinics, from January 2009 to August 2014, due to a suspected NSAID hypersensitivity. Results: We included 119 patients, with a median age of nine years (P 25 ---P 75 : 5---14). Ibuprofen was the commonest implicated NSAID in the patients' reports (n = 94---79%). After DPT, NSAID hypersensitivity was confirmed in nine (7.6%) patients, excluded in 93 (78.2%) and was inconclusive in 17 (14.3%). In the majority (n = 95---79.8%), the reaction occurred in the first 24 h after intake. Eighty-four patients (70.6%) reported only cutaneous manifestations and 18 (15.1%) had systemic symptoms. Anaphylaxis represented a relative risk to NSAID hypersensitivity confirmation. No association was found for atopy and the number of previous reactions. Conclusion: In our study, NSAID hypersensitivity was confirmed in a small proportion of the patients with a previous reported reaction. Ibuprofen was the most implicated drug with urticaria/angio-oedema as the commonest manifestation. Anaphylaxis was associated with confirmed drug hypersensitivity. The drug provocation test was essential to establish the diagnosis.

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Section: Discussionmentioning

confidence: 65%

Non-steroidal anti-inflammatory drug hypersensitivity in children

Alves

Romeira

Abreu

et al. 2017

Allergologia et Immunopathologia

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“…The association of NSAID hypersensitivity with atopy and asthma is consistent with previous publications. 9,10,32 We made clinically dictated modifications in the oral provocation protocol because of the accumulated experience with the first few patients. The original protocol for urticaria and angioedema reactions among normal individuals, adapted from the published data, 33 called for a small initial dose with doubling every 30 minutes (similar to oral provocation protocols with antibiotics).…”

Section: Discussionmentioning

confidence: 99%

“…8 NSAID hypersensitivity, however, seems to be associated positively with the presence of atopy. 4,9 Among highly selected children with difficult-to-treat asthma, the incidence of aspirin-exacerbated respiratory disease (AERD) is almost 30%, mostly among female patients with associated sinusitis and early onset of disease 10 and in the context of the triad of AERD, nasal polyps, and severe asthma. 11 There is, however, significant controversy regarding the importance of these challenge-derived findings for selected patients in the routine treatment of children with asthma.…”

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confidence: 99%

Early Presentation With Angioedema and Urticaria in Cross-reactive Hypersensitivity to Nonsteroidal Antiinflammatory Drugs Among Young, Asian, Atopic Children

et al. 2005

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ABSTRACT. Objective. Nonsteroidal antiinflammatory drugs (NSAIDs), mainly ibuprofen, are used extensively among children as analgesic and antipyretic agents. Our initial survey in the Kendang Kerbau Children's Hospital in Singapore showed NSAIDs to be the second most common adverse drug reaction-causing medications among children of Asian descent. We attempted to characterize the clinical and epidemiologic profile of NSAID reactions in this group of patients.Methods. A retrospective case series from a hospitalbased pediatric drug allergy clinic was studied. A diagnosis of NSAID hypersensitivity was made with a modified oral provocation test. Atopy was evaluated clinically and tested with a standard panel of skin-prick tests. We excluded from analysis patients with any unprovoked episodes of urticaria and/or angioedema, patients <1 year of age, and patients who refused a diagnostic challenge test.Results. Between March 1, 2003, and February 28, 2004, 24 patients, including 14 male patients (58%) and 18 Chinese patients (75%), with a mean age of 7.4 years (range: 1.4 -14.4 years), were diagnosed as having crossreactive NSAID hypersensitivity. A family history consistent with NSAID hypersensitivity was elicited for 17% of patients. None of the patients reported any episodes of angioedema/urticaria unrelated to NSAIDs. The median cumulative reaction-eliciting dose was 7.1 mg/kg. Facial angioedema developed for all patients (100%) and generalized urticaria for 38% of challenged patients, irrespective of age. There was no circulatory compromise, but respiratory symptoms of tachypnea, wheezing, and/or cough were documented for 42% of patients. A cross-reactive hypersensitivity response to acetaminophen was documented for 46% of our patients through their history and for 25% through diagnostic challenge. Compared with patients with suspected adverse drug reactions to antibiotics, patients in the NSAID group were older (7.4 vs 4.8 years) and more likely to have a diagnosis of asthma (odds ratio: 7.5; 95% confidence interval: 3.1-19).Conclusions. Early presentations of facial angioedema and urticaria are key features of dose-and potency-dependent, cross-reactive reactions to NSAIDs in a subpopulation of young, Asian, atopic children. Significant overlap with acetaminophen hypersensitivity, especially among very young patients, for whom the use of a cyclooxygenase-2-specific medication may not be feasible, severely limits options for medical antipyretic treatment. A spirin and other nonsteroidal antiinflammatory drugs (NSAIDs) are a widely used group of medications whose mechanism of action involves inhibition of prostaglandin production through blockade of the cyclooxygenase (COX) enzymes known as COX-1 and COX-2. This blockade also results in the shunting of arachidonic acid metabolism toward the 5-lipoxygenase pathway, resulting in increased production and release of cysteinyl leukotrienes.Acetaminophen, the most ubiquitously used antipyretic medication for children worldwide, is an "old" medication whose mechanism of a...

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“…Hypersensitivity reactions to aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are common in the population, and they are observed more often in young atopic individuals [1]. Different clinical patterns of reactions involving the skin, respiratory tract, or generalized have been described, and 4 forms of clinical presentation have been proposed: (1) respiratory (aspirin-exacerbated respiratory disease), (2) cutaneous (urticaria and angioedema), (3) mixed, and (4) systemic (anaphylaxis) [2].…”

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confidence: 99%

A Novel Phenotype of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity

Sánchez‐Borges¹,

Capriles‐Hulett

Caballero‐Fonseca

2009

World Allergy Organization Journal

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BackgroundSome nonsteroidal anti-inflammatory drug (NSAID)-hypersensitive patients develop adverse reactions when challenged with weak cyclooxygenase 1 (COX-1) inhibitors.ObjectivesTo investigate the prevalence and clinical features of this high-risk population.Materials and methodsPatients from 2 outpatient allergy clinics consulting between October 2005 and October 2007 because of adverse reactions to classic NSAIDs were submitted to confirmatory double-blind oral challenges with the suspected NSAID and with acetaminophen, preferential and/or specific COX-2 inhibitors. Patients were then classified as low-risk and high-risk groups according to the results of provocation tests.ResultsThree hundred three patients were studied: 179 (59.0%) were tolerant to acetaminophen and the selective COX-2 inhibitors (low-risk group), whereas 124 (40.9%) developed reactions to at least one of the ''low COX-1 inhibitors'' (high-risk group). No distinctive demographic or clinical characteristics were present when both groups of patients were compared.ConclusionsA large proportion of patients sensitive to classic NSAIDs cannot tolerate the weak COX-1 inhibitors. Oral challenges should be performed by trained specialists to advise these patients about the use of NSAIDs.

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Atopy is a risk factor for non-steroidal anti-inflammatory drug sensitivity

Cited by 152 publications

References 28 publications

Non-steroidal anti-inflammatory drug hypersensitivity in children

Non-steroidal anti-inflammatory drug hypersensitivity in children

Early Presentation With Angioedema and Urticaria in Cross-reactive Hypersensitivity to Nonsteroidal Antiinflammatory Drugs Among Young, Asian, Atopic Children

A Novel Phenotype of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity

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