Characteristics of NSAID‐induced hypersensitivity reactions in childhood

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are available as over-the-counter drugs, and they are commonly used in children for their antipyretic, analgesic, and anti-inflammatory effects. NSAIDs are among the most frequently reported drugs associated with hypersensitivity reactions and even with anaphylaxis. A complete evaluation of the patients based on reported clinical manifestations, timing of the reaction, the presence of underlying disease, and reactions to other NSAIDs allows clinicians to stratify children with a history of reaction to NSAIDs. Although NSAID-induced hypersensitivity reactions have mainly been investigated in adults, recent studies have aimed to explore their epidemiology in the pediatric population. This review will cover the current understanding of clinical manifestations, the risk factors, and the different phenotypes of NSAID-induced hypersensitivity reactions with a comprehensive overview of the epidemiologic data from past to present and the practical approach to the management of NSAID hypersensitivity in children and adolescents.

Recent developments and highlights in drug hypersensitivity

“…Precise definitions and provision of background, in a standardized available questionnaire, are helpful to correctly classify DHRs . Although in NSAID hypersensitivity, the current classification needs a revision including new entities as blended reactions …”

“…[62][63][64][65] Precise definitions and provision of background, in a standardized available questionnaire, are helpful to correctly classify DHRs. 5,66,67 Although in NSAID hypersensitivity, the current classification needs a revision 68,69 including new entities as blended reactions. 55 Predictive models have been designed for the diagnosis of BL allergy, based only on clinical history.…”

Hypersensitivity reactions to non‐steroidal anti‐inflammatory drugs in children

“…• COX1 -enzym znajdujący się w licznych tkankach, który odgrywa podstawową rolę w fizjologicznej regulacji pracy narządów, m.in. śluzówki przewodu pokarmowego, nerek (poprzez utrzymanie prawidłowego przepływu krwi), agregacji płytek, homeostazie naczyniowej; • COX2 -enzym ulegający aktywacji w stanie zapalnym, jego synteza jest pobudzana za pomocą cytokin, mitogenów oraz endotoksyn produkowanych przez aktywowane makrofagi i inne komórki stanu zapalnego; • COX3 -stanowi punkt uchwytu działania paracetamolu, który w małych stężeniach jest słabym inhibitorem COX1 i COX2; spotykana jest głównie w tkance mózgowej, jej rola nie została do końca poznana [6]. Praktyczny wymiar ma znajomość podziału NLPZ w zależności od siły działania na poszczególne cyklooksygenazy (tab.…”

“…ibuprofenu, 15-20 mg/kg m.c. kwasu acetylosalicylowego z uwzględnieniem maksymalnych dawek leków podawanych dorosłym [6].…”

On early metabolite exposure influencing asthma outcome, the risk of hymenoptera allergy in a birth cohort, and improvement of food allergy management at school

“…These are reviewed by Kudryavtseva et al who also address specific treatment aspects in children. In the third review, Cavkaytar et al offer a comprehensive overview of epidemiologic data and the practical approach to the management of NSAID hypersensitivity in children and adolescents.…”