Characteristics of subjects experiencing hypersensitivity to non-steroidal anti-inflammatory drugs: patterns of response

Doña, Inmaculada; Blanca‐López, Natalia; Cornejo-García, José Antonio; Torres, Marı́a José; Laguna, José Julio; Fernández, J.; Rosado, Ana; Rondón, Carmen; Campo, Paloma; Agúndez, José A. G.; Blanca, Miguel; Cantó, Gabriela

doi:10.1111/j.1365-2222.2010.03651.x

Cited by 181 publications

(340 citation statements)

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“…Another drug of interest was metamizole, a frequent elicitor of SRs [9,35] in countries where it is still widely prescribed [1,8,10]. In our study, positive skin test or BAT results became negative over time, as usually occurs in IgEmediated responses to drugs [27].…”

Section: Discussionmentioning

confidence: 63%

“…Current data on arylpropionic acid derivatives indicate that these drugs are increasingly involved in immediate SRs, which are now almost as frequent as SRs to pyrazolone derivatives [1,2,8]. Although these drugs generate immunogenic adducts and induce T-cell responses [34], the potential adducts involved in selective immediate allergic reactions and the presence of specific IgE antibodies have not yet been addressed [9].…”

Section: Discussionmentioning

confidence: 99%

“…From a total of 203 patients with immediate SRs to NSAIDs, we identified 16 who reacted to 2 or 3 chemically unrelated NSAIDs and were tolerant to ASA. In contrast to hypersensitivity to BLs [21,31], patients with DHRs to NSAIDs often experience repeated episodes as a result of incomplete knowledge about how to address the reactions [8,32]. Although multiple allergy to drugs was first reported more than 20 years ago [19,20], studies to elucidate the mechanism have been carried out only for T cell-dependent reactions, where sensitization to multiple drugs could occur both simultaneously and sequentially [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…The drug challenge was performed using previously described concentrations [8]. In patients who presented more than 2 episodes with the same drug, challenge testing with the culprit drug was not performed.…”

Section: Allergology Workupmentioning

confidence: 99%

“…In contrast to reactions to ß-lactams (BLs), which are immunologically mediated [6], DHRs to NSAIDs may be induced by both specific immunological mechanisms (allergic or selective reactions [SRs]) and mechanisms not based on immunological recognition (cross-hypersensitivity reactions [CRs]) [7]. Although the latter are responsible for the largest number of affected patients in some countries [1,8], SRs account for a considerable proportion in others [9,10]. SRs have been reported to all NSAIDs, independently of their capacity for inhibiting the COX-1 enzyme [9,11], and in all age ranges, including children [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Pérez-Alzate

Cornejo-García

Pérez‐Sánchez

et al. 2017

J Investig Allergol Clin Immunol

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Background: Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors. Methods: Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration. Results: From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients. Conclusions: Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Allergology Workupmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Pérez-Alzate

Cornejo-García

Pérez‐Sánchez

et al. 2017

J Investig Allergol Clin Immunol

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Adverse Drug Reactions Attributed to Ibuprofen

2015

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Basophil activation after nonsteroidal anti‐inflammatory drugs stimulation in patients with immediate hypersensitivity reactions to these drugs

et al. 2014

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are the drugs most frequently involved in allergic reactions of which two main types exist: IgE-mediated and crossintolerance. The diagnosis of crossintolerance reactions is often based on the drug provocation test. The potential value of the basophil activation test (BAT) was evaluated using different basophil markers in the diagnosis of patients with crossintolerance to NSAIDs and cutaneous symptoms. We studied 46 patients with crossintolerance to NSAIDs and 45 tolerant controls. BAT was performed with acetyl salicylic acid, paracetamol, diclofenac, dipyrone, naproxen, and ibuprofen at four different concentrations using CD193 and CD203c as basophil markers and CD63 as activation marker. We compared BAT results using CD193 1 or CD193 1 CD203c 1 for basophil selection and found a significant increase in the stimulation index when using CD193 1 CD203c 1 in both patients and controls (P 5 0.004 and P 5 0.017, respectively). Selection of living cells only produced an increase in basophil stimulation in patients for both CD193 1 and CD193 1 CD203c 1 (P < 0.001 for both), whereas in controls there was no change with CD193 1 and a decrease with CD193 1 CD203c 1 (P 5 0.001). We found that CD193 1 CD203c 1 increased the percentage of positive cases in patients and controls when compared with CD193 1 . When excluding dead cells, there was an increase of 21.7% in patients and 10% in controls. These results indicate that using CD193 1 CD203 1 , excluding dead cells, is the best approach for BAT although this test is not recommended for the diagnosis of patients with crossintolerance to NSAIDs owing to its low sensitivity and specificity. V C 2014 International Society for Advancement of Cytometry Key terms hypersensitivity; nonsteroidal anti-inflammatory drugs; idiosyncratic reactions; basophils; CD63; CD193; CD203c NONSTEROIDAL anti-inflammatory drugs (NSAIDs) are the drugs most frequently involved in immediate or acute hypersensitivity reactions, accounting for 20-25% of patients evaluated in allergy units, with two main mechanisms involved (1-3). One is mediated by drug-specific-IgE antibodies and reactions occur with one NSAID but there is tolerance to other nonchemically related drugs (4,5). These reactions are known as single NSAID induced hypersensitivity reactions and involve NSAIDs such as paracetamol (6), acetyl salicylic acid (ASA) (7), diclofenac (8), ketorolac (9), dipyrone (10,11), and cyclooxygenase-2 selective inhibitors (COX-2) (12). The other type of reaction is mediated by a pharmacological mechanism in which the inhibition of cyclooxygenase-1 enzyme (COX-1) leads to a decrease in the synthesis of prostaglandin E 2, which in turn hampers the production of sulphidoleukotrienes

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Characteristics of subjects experiencing hypersensitivity to non-steroidal anti-inflammatory drugs: patterns of response

Abstract: Cutaneous hypersensitivity reactions by CI to NSAIDs are the most frequent entities induced by these compounds. In addition to aspirin, other NSAIDs are taking on a predominant role. Atopy can be a predisposing factor in patients with CI.

Cited by 181 publications

References 28 publications

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Adverse Drug Reactions Attributed to Ibuprofen

Basophil activation after nonsteroidal anti‐inflammatory drugs stimulation in patients with immediate hypersensitivity reactions to these drugs

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