Diagnosis of Ibuprofen allergy through oral challenge

Abstract

Ibuprofen is the most commonly used non-steroidal anti-inflammatory drug (NSAID) and is the only NSAID approved for use in infants less than three months of age. 1 It is available over-the-counter for the treatment of fever, inflammation and pain, and is often prescribed to treat inflammatory conditions. Over the past decade, there has been a reported shift towards Ibuprofen consumption as an over-the-counter drug, with 70% of ibuprofen being purchased without prescription in 2015, as well as an overall increase in consumption. 1 However, there has been a paralleled increase in reports of severe adverse reactions to NSAID, such as anaphylaxis, with Ibuprofen being the most common trigger of all NSAIDs. 1,2 Despite the obvious need, there is little research on the diagnosis and management of patients and in particular children with reported Ibuprofen reactions. We aimed to evaluate diagnosis and management of NSAID allergy in children (defined as children that are 18 years old or younger). This cohort study, with both retrospective and prospective recruitment, took place between January 2017 and July 2019 at the Montreal Children's Hospital. All children presenting to the Montreal Children's Hospital for suspected NSAID allergy were included in this study. After obtaining parental consent, a standardized questionnaire was filled out in order to collect data on demographics, clinical characteristics and management of the suspected Ibuprofen reaction. Table 1 displays the results of these questionnaires. The treating allergist then assessed the patient and decided if they were eligible to undergo a drug provocation test (DPT) (10% and 90% of the oral dose) to the culprit NSAID. As per guidelines set by the American Academy of Allergy, Asthma and Immunology (AAAAI), controlled oral provocation with the suspected allergen was used as it is considered to be the most conclusive way to confirm a diagnosis. 3 Children were observed

NSAID Hypersensitivity in the Pediatric Population: Classification and Diagnostic Strategies

“…5 Increasing age was an independent risk factor for ibuprofen hypersensitivity. 5 The prevalence of ibuprofen hypersensitivity in children and adolescents with mild to moderate asthma was 2% with a 95% confidence interval of 0.2-7%. 55 NSAIDs act by competing with arachidonic acid to bind its site of action on a COX enzyme, leading to a reduction in the synthesis of prostaglandins and thromboxane in the arachidonic acid pathway.…”

“…32,[92][93][94] Even delayed contact hypersensitivity proven with patch tests was reported in adults with bufexamac, indomethacin, and etofenamate. 95 Taking the studies evaluating a pediatric population with a proven NSAID-H into consideration, 5,25,[27][28][29][30][31][32][33][34][35][36][37][38]62,63 three patients with MPE induced by paracetamol and ibuprofen, two with FDE induced by paracetamol and another with erythema multiforme induced by ibuprofen were reported. 5,32,33,42…”

“…95 Taking the studies evaluating a pediatric population with a proven NSAID-H into consideration, 5,25,[27][28][29][30][31][32][33][34][35][36][37][38]62,63 three patients with MPE induced by paracetamol and ibuprofen, two with FDE induced by paracetamol and another with erythema multiforme induced by ibuprofen were reported. 5,32,33,42…”

“…[2][3][4] Thus, they can be considered as over-The-counter drugs used at much higher rates than based on prescriptions alone. 1,2,5,6 The class of non-steroidal anti-inflammatory agents is comprised of structurally divergent subgroups of drugs with similar pharmacological and adverse effects (Table 1). Aspirin (acetylsalicylic acid) (ASA), the first synthesized analgesic, originates from salicin, which is the active ingredient of willow bark, and has been used since the time of the ancient Egyptians in traditional medicine.…”

Developments in the field of allergy in 2020 through the eyes of Clinical and Experimental Allergy

“…In 2020, we published papers describing drug desensitization through graded oral challenge 91 and screening for low-risk delabelling through five simple questions. 92 Other drug allergy work in the journal covered severe cutaneous adverse reactions in children, general anaesthetic allergy testing, oral challenge to ibuprofen, use of CD154 in drug allergy diagnosis and reviews of reactions to iodinated contrast media and to the non-steroidal anti-inflammatory drug metamizole, which has been withdrawn from the market in some countries due to the rare occurrence of agranulocytosis [93][94][95][96][97]98,99…”