EAACI/ENDA Position Paper: Diagnosis and management of hypersensitivity reactions to non‐steroidal anti‐inflammatory drugs (NSAIDs) in children and adolescents

Kidon, Mona; Blanca‐López, Natalia; Gomes, Eva; Terreehorst, Ingrid; Tanno, Luciana Kase; Ponvert, C.; Chin, Chiang Wen; Caubet, Jean-Christoph Roger J-P; Soyer, Özge; Mori, Francesca; Blanca, Miguel; Atanasković-Marković, Marina

doi:10.1111/pai.12915

Cited by 83 publications

(109 citation statements)

References 75 publications

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“…In general, desensitization has been shown to be useful to maintain the first election treatment in multiple groups of drugs, including anticonvulsants, antituberculosis medication, antibiotics, NSAIDs and others, in both IR and NIR, and even in paediatric population and patients with multiple autoimmune disorders …”

Section: Novel Tools For Managing Dhrmentioning

confidence: 99%

“…184 Moreover, long premedication protocols increase costs, side effects and length of hospital stay. 185 In general, desensitization has been shown to be useful to maintain the first election treatment in multiple groups of drugs, 67 including anticonvulsants, 13 antituberculosis medication, 186,187 antibiotics, [188][189][190] NSAIDs 96,183,191,192 and others, 193,194 in both IR 96,174,178,188,191,194 and NIR, 96,186,187,190,193 and even in paediatric population 86,188,192 and patients with multiple autoimmune disorders. 189…”

Section: Novel Tool S For Manag Ing Dhrmentioning

confidence: 99%

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Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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Section: Novel Tools For Managing Dhrmentioning

confidence: 99%

Section: Novel Tool S For Manag Ing Dhrmentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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“…Paracetamol skin testing, even used for some research purposes, is of little relevance in children . Nevertheless, skin tests are mainly performed for research purposes and are of little value for SRs, while in clinical practice, the OPT remains the gold standard to diagnose NSAID‐H as also indicated in EAACI/ENDA position paper by Kidon et al It is important to note that such test is contraindicated in case of severe delayed reactions, such as TEN, SJS, AGEP, and DRESS even it may not be appropriate to undertake an OPT with the culprit NSAID in case of an anaphylactic reaction in the history. When undertaking the OPT, culprit NSAID should be administered at increasing doses under strict medical surveillance .…”

Section: Practical Approach To Diagnose Nsaid‐h In Childhoodmentioning

confidence: 99%

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

Cavkaytar

Toit

Caimmi

2018

Pediatric Allergy Immunology

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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.

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“…Nonsteroidal anti-inflammatory drugs (NSAIDs) induced anaphylaxis is most commonly due to a non-IgE mediated mechanism, 54 although immediate IgE and delayed T-cell reactions can occur. 55 NSAIDs inhibit cyclooxygenase, increasing production of leukotrienes which can manifest as bronchospasm, urticaria, and angioedema. 54 Subsequent skin tests are typically negative due to the lack of mast cell involvement.…”

Section: Nonsteroidal Anti-inflammatory Drugsmentioning

confidence: 99%

An update on allergy and anaphylaxis in pediatric anesthesia

Stepanovic

Sommerfield

Lucas

et al. 2019

Pediatric Anesthesia

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Childhood allergy is common, and increasing. Many children are incorrectly labeled as having allergy or adverse drug reactions. This can pose a dilemma for anesthetists and lead to a change in practice or drug selection. We review the pathophysiology of hypersensitivity reactions and the implications for anesthesia of food allergy, atopy, and family history of allergy in children. The epidemiology of anaphylaxis is discussed. We discuss the common triggers of perioperative anaphylaxis in children and explore emerging triggers including chlorhexidine and sugammadex. Accurate data on pediatric perioperative anaphylaxis is limited worldwide, with marked geographic variation. This highlights the need for accurate local, district and/or nationwide incident reporting. The clinical features, diagnosis, and management of anaphylaxis under anesthesia are discussed. We review the process of expert allergy testing following a suspected case of anaphylaxis to guide future safe anesthesia administration. The preoperative consultation is an opportunity for referral for allergy testing to allow de‐labeling. This has the potential for improved antibiotic stewardship and more effective treatment with first‐line therapeutic agents.

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EAACI/ENDA Position Paper: Diagnosis and management of hypersensitivity reactions to non‐steroidal anti‐inflammatory drugs (NSAIDs) in children and adolescents

Cited by 83 publications

References 75 publications

Recent developments and highlights in drug hypersensitivity

Recent developments and highlights in drug hypersensitivity

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

An update on allergy and anaphylaxis in pediatric anesthesia

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