NSAID Hypersensitivity in the Pediatric Population: Classification and Diagnostic Strategies

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently administered drugs, mainly for their antipyretic, but also for pain-relieving and anti-inflammatory effects in children. NSAIDs are composed of structurally divergent subgroups of drugs with similar pharmacological and adverse effects. Aspirin originates from salicin and was the first synthesized analgesic. As a prototype of NSAIDs; aspirin-induced hypersensitivity reactions were first reported, but subsequently, other phenotypes of hypersensitivity reactions were also described with aspirin and other NSAIDs. There are certain challenging aspects of NSAID-hypersensitivity in the pediatric population that need to be further investigated. These include the effect of age on drug metabolism and the natural history of the various phenotypes of NSAID-hypersensitivity, the effect of certain co-factors (infections, exercise) on NSAID-hypersensitivity, and diagnostic clinical and laboratory biomarkers clarifying the endotypes. In recent years, a non-negligible number of case series, studies and expert panel reports have been published in this field with some novel features and diagnostic modalities in the pediatric population. With the current review; the clinical phenotypes and diagnostic and management modalities of suspected NSAID-induced hypersensitivity reactions in childhood and adolescence were explained and updated by examining past and current publications.

Practical Approach to Hypersensitivity to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Children

“…Of the 56 children referred to our clinic who were “labeled” as having hypersensitivity to NSAIDs, we confirmed only 17 cases of allergy (30.4%) after analyzing DPT results; other reactions were non-specific and most probably linked to the patient’s main underlying disease. The most often reported culprit drug was ibuprofen, which is consistent with the results of other studies [ 6 , 8 , 14 ]. This seems obvious, as ibuprofen is confirmed to be the drug of first choice in the treatment of inflammatory pain in children, and, as a result, it is the most commonly prescribed anti-inflammatory drug in children.…”

Opioid Sparing by ERAS Protocol in Cleft Lip and Palate Craniofacial Surgery

“…This can lead to increased risk for adverse events including bleeding complications, cutaneous reactions, respiratory symptoms, and severe anaphylaxis. 32 However, there is conflicting data about whether NSAID use increases bleeding in the postoperative period of pediatric surgical procedures. [4][5][6] Among the studies there is a consensus of NSAID safety for pain management with close monitoring of possible adverse effects.…”

Drug-Induced Anaphylaxis in Children

“…NSAIDs are a significant cause of pediatric DIA, with ibuprofen often leading the list. Anaphylaxis was reported with a rate between 9% and 32% in children and adolescents with proven NSAID hypersensitivity [ 76 ]. The classification of acute HRs to NSAIDs is outlined in both European and American guidelines.…”