Discrepancies in the diagnosis and classification of nonsteroidal anti-inflammatory drug hypersensitivity reactions in children

Abstract

This study suggests the presence of different phenotypes which do not fit into the current classifications in children with NSAID hypersensitivity.

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

“…Zambonino et al reported that mainly food allergy, but also inhalant allergen sensitization, was significantly more frequent in CI children and adolescents compared to SRs and healthy controls, and sensitization to, particularly, house dust mites, Olea europaea, and Alternaria was the most frequently associated inhalant allergens . Nevertheless, these findings were not confirmed in other studies . The clinical manifestations occurring during the index reaction may also be predictive of the result of a provocation test.…”

“…Cutaneous symptoms such as urticaria and angioedema are the most frequent reactions appearing during NSAID‐induced hypersensitivity reactions in children . In adults, the most frequent clinical manifestation is CI type urticaria and/or angioedema and to a lesser extent respiratory involvement, whereas in children, there are contradictory results . In one of the largest published series, there were slightly more cross‐intolerant patients than selective responders, but this was not the case in smaller studies .…”

“…Also, in a recent publication on severe drug‐induced reactions in children, the authors reported one case of metamizole‐induced Stevens‐Johnson syndrome in a cohort of 58 patients . Apart from these patients, other recent publications do not report the case of other children presenting with a confirmed NSAID delayed reaction . NSAID‐induced organ‐specific reactions also exist in this group, but the exact prevalence in children is not known.…”

“…According to ENDA/EAACI/GA 2 LEN recommendations, the five aforementioned phenotypes of NSAID‐H are mainly based on authors’ expertise and published evidence; these studies mainly focus on the adult population (Table ). Subsequent to the publication of these recommendations, several authors focused their studies on the pediatric population, describing similar and divergent phenotypes of NSAID‐H in children …”

“…The first studies on NSAID‐H in children aimed to find out the rate of aspirin hypersensitivity (ASA‐H) in asthmatic and healthy populations regardless of a suspected drug‐induced history, which were detected by aspirin provocation tests and highlighted a prevalence of 0%‐33% and 0.32%‐0.55%, respectively (Table ). In more recent studies, children and adolescents with a suspected history of NSAID‐induced hypersensitivity reaction were challenged with the culprit drug in order to define the prevalence of proven NSAID‐H, which is assessed between 8% and 68% in different populations . As an important finding in these studies, the most commonly implicated culprit NSAIDs resulting in confirmed hypersensitivity in young children were ibuprofen, paracetamol and to a lesser extent metamizole, while diclofenac, naproxen, aspirin, and ketoprofen were more common in adolescents .…”