Respiratory hypersensitivity reactions to NSAIDs in Europe: the global allergy and asthma network (GA<sup>2</sup>LEN) survey

Makowska, Joanna; Burney, Peter; Jarvis, Déborah; Keil, Thomas; Tomassen, Peter; Bislimovska, Jovanka Karadzinska; Brożek, Grzegorz; Bachert, Claus; Bælum, Jesper; Bindslev‐Jensen, Carsten; Bousquet, J; Bousquet, P.; Carlsen, Kai‐Hakon; Dahlén, SE; Dahlén, Barbro; Fokkens, W. J.; Forsberg, Bertil; Gjomarkaj, Mark; Howarth, Peter H.; Salagean, E; Janson, Christer; Kasper, Łukasz; Kraemer, Ursula; Louiro, C; Lundbäck, Bo; Минов, Јордан; Niżankowska‐Mogilnicka, Ewa; Papadopoulos, Nikos; Sakellariou, A.; Todo-Bom, Ana; Toskala, Elina; Zejda, Jan; Zuberbier, Torsten; Kowalski, Marcin

doi:10.1111/all.12941

Cited by 40 publications

(26 citation statements)

References 32 publications

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“…About a quarter of patients with a diagnosed hypersensitivity reaction to NSAIDs present to medical attention, before 18 years of age . In a large questionnaire survey in Europe, prevalence of NSAID intolerance in subjects between 10 and 20 years was estimated at about 10%, and it was significantly lower in children under the age of 10 years . However, there is significant variability between published studies, probably due to geographic differences, population and subpopulations (ethnical groups) studied, the case definition used as well as other less well‐defined factors.…”

Section: Epidemiology Risk Factors and Drugs Involved In Pediatric mentioning

confidence: 99%

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

Kidon

Blanca‐López

Gomes

et al. 2018

Pediatric Allergy Immunology

104

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Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in the pediatric population as antipyretics/analgesics and anti-inflammatory medications. Hypersensitivity (HS) reactions to NSAID in this age group, while similar to adults, have unique diagnostic and management issues. Although slowly accumulating, published data in this age group are still relatively rare and lacking a unifying consensus. This work is a summary of current knowledge and consensus recommendations utilizing both published data and expert opinion from the European Network of Drug Allergy (ENDA) and the Drug Hypersensitivity interest group in the European Academy of Allergy and Clinical Immunology (EAACI). This position paper summarizes diagnostic and management guidelines for children and adolescents with NSAIDs hypersensitivity.

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Section: Epidemiology Risk Factors and Drugs Involved In Pediatric mentioning

confidence: 99%

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

Kidon

Blanca‐López

Gomes

et al. 2018

Pediatric Allergy Immunology

104

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“…The association of NSAIDs as potential agents inducing respiratory symptoms was made by logistic regression analysis. Results showed a mean prevalence of 1.9% with a variation rank from 0.9 to 4.9 in the different centers included 67Table 2Proposed guidelines for the differential diagnosis of clinical manifestation where skin symptoms are the predominantEntitiesNIUANECDMix reactionSNIUASNIDHRCategoryCICICISRSRUrticariaYesYesYesYesYesAngioedemaYes/NoYes/NoYes/NoYes/NoYes/NoAnaphylaxis+++++++–Time interval1–6 hoursVariable2–24 hours≤1 hour6–24 hours*System symptomsNoNoYes/NoYes/NoNo*STNo valueNo valueNo valueOptional*Optional*Skin biopsyOptionalOptionalOptionalOptionalYesNature evolutionMay disappearVariableVariableMay disappearUnknownCorticoidsGoodVariableGoodGood Notes: The interval can be shorter or in rarer instances longer than 24 hours.…”

Section: Prevalencementioning

confidence: 99%

<p>NSAID-induced reactions: classification, prevalence, impact, and management strategies</p>

Blanca‐López¹,

Soriano²,

García‐Martín³

et al. 2019

JAA

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are the leading cause of hypersensitivity drug reactions. The different chemical structures, cyclooxygenase 1 (COX-1) and/or COX-2 inhibitors, are taken at all ages and some can be easily obtained over the counter. Vasoactive inflammatory mediators like histamine and leukotriene metabolites can produce local/systemic effects. Responders can be selective (SR), IgE or T-cell mediated, or cross-intolerant (CI). Inhibition of the COX pathway is the common mechanism in CI, with the skin being the most frequent organ involved, followed by the lung and/or the nose. An important number of cases have skin and respiratory involvement, with systemic manifestations ranging from mild to severe anaphylaxis. Among SR, this is the most frequent entity, often being severe. Recent years have seen an increase in reactions involving the skin, with many cases having urticaria and/or angioedema in the absence of chronic urticaria. Aspirin, the classical drug involved, has now been replaced by other NSAIDs, with ibuprofen being the universal culprit. For CI, no in vivo/in vitro diagnostic methods exist and controlled administration is the only option unless the cases evaluated report repetitive and consistent episodes with different NSAIDs. In SR, skin testing (patch and intradermal) with 24–48 reading can be useful, mainly for delayed T-cell responses. Acetyl salicylic acid (ASA) is the test drug to establish the diagnosis and confirm/exclude CI by controlled administration. Desensitization to ASA has been extensively used in respiratory cases though it can also be applied in those cases where it is required.

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“…[6][7][8] Up to 45% of the CRSwNP patients will develop asthma, and 8-26% cannot tolerate non-steroidal anti-inflammatory drugs (NSAIDs) having NSAID-exacerbated respiratory disease (NERD), also called aspirin exacerbated respiratory disease (AERD). 1,[9][10][11] In the NERD there is found a strong eosinophilic hyperplastic inflammation on the mucosa of the common airways. 12 Patients with uncontrolled CRS after appropriate medical treatment will usually undergo endoscopic sinus surgery (ESS).…”

Section: Introductionmentioning

confidence: 99%

Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study

Virkkula

Penttilä

Vento

et al. 2020

Allergy�Rhinol (Providence)

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Background Developing tools to identify chronic rhinosinusitis with nasal polyps (CRSwNP) patients requiring surgical treatment would help clinicians treat patients more effectively. The aim of this retrospective cross-sectional study was to identify cut-off values for eosinophil percentage, nasal polyps (NP), and Lund-Mackay (LM) scores that may predict the need for surgical treatment in Finnish CRSwNP patients. Methods Data of CRSwNP patients (N = 378) undergoing consultation for ESS in 2001–19 were used. Data was collected from patient records and Lund-Mackay scores were determined from sinus computed tomography scans. The percentage of eosinophils was microscopically evaluated from the polyp samples available (n = 81). Associations were analyzed by Mann Whitney U test, and cut-off values by the area under the receiver operating characteristic curve (AUROC). Results ESS was performed to 293 (77.5%) of patients. Polyp eosinophilia was associated significantly with ESS (p = 0.001), whereas peripheral blood eosinophil count, LM- score and endoscopic NP- score were not (p > 0.05). AUROC values (95% CI) for detecting those needing ESS were for polyp eosinophilia 0.71 (0.60–0.83), p = 0.001, for LM score 0.59 (0.50–0.67), p = 0.054; for NP score 0.56 (0.48–0.64), p = 0.17, and for blood eosinophil count 0.68 (0.46–0.90), p = 0.08. With the threshold value of polyp eosinophilia (>25%), the sensitivity and specificity were optimal for detecting the group needing ESS from the group not undergoing ESS. The cut-off value of blood eosinophil count (>0.26 × 109/L) had relatively good, yet statistically insignificant (underpowered), predictive potential. Moderate cut-off values were found for endoscopic LM score (≥14/24) and NP score (≥4/8). Conclusions Polyp eosinophilia (>25%) predicted ESS among Finnish hospital-level CRSwNP patients. A future challenge would be to find less invasive and cost-effective clinical factors predicting uncontrolled CRSwNP.

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Respiratory hypersensitivity reactions to NSAIDs in Europe: the global allergy and asthma network (GA²LEN) survey

Abstract: Our study documented significant variation between European countries in the prevalence of NSAID-induced respiratory hypersensitivity reactions, and association with chronic airway diseases, but also with environmental factors.

Cited by 40 publications

References 32 publications

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

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

<p>NSAID-induced reactions: classification, prevalence, impact, and management strategies</p>

Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study

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Respiratory hypersensitivity reactions to NSAIDs in Europe: the global allergy and asthma network (GA2LEN) survey

Abstract: Our study documented significant variation between European countries in the prevalence of NSAID-induced respiratory hypersensitivity reactions, and association with chronic airway diseases, but also with environmental factors.

Cited by 40 publications

References 32 publications

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

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

<p>NSAID-induced reactions: classification, prevalence, impact, and management strategies</p>

Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study

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Respiratory hypersensitivity reactions to NSAIDs in Europe: the global allergy and asthma network (GA²LEN) survey