Adverse and Hypersensitivity Reactions to Prescription Nonsteroidal Anti-Inflammatory Agents in a Large Health Care System

Blumenthal, Kimberly G.; Lai, Kenneth H.; Huang, Mingshu; Wallace, Zachary S; Wickner, Paige G.; Zhou, Li

doi:10.1016/j.jaip.2016.12.006

Cited by 60 publications

(46 citation statements)

References 55 publications

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“…Therefore, the real prevalence of these cases is probably higher than the estimations found here. A retrospective study using EHR data in Boston (USA) found that 0.3% of outpatients have hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs (NSAIDs) within 1 year of prescription …”

Section: Discussionsupporting

confidence: 84%

“…A retrospective study using EHR data in Boston (USA) found that 0.3% of outpatients have hypersensitivity reactions to nonsteroidal antiinflammatory drugs (NSAIDs) within 1 year of prescription. 19 Skin and subcutaneous tissue disorders and immune system dis- Antibacterials for systemic use (~53%) and anti-inflammatory/antirheumatic products together with analgesics (~19%) were the most frequently reported suspected drugs in the database. These results are in line with findings from other investigations.…”

Section: The Overall 5-year Prevalence For Patients With Hypersensitimentioning

confidence: 99%

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Drug-induced hypersensitivity: A 5-year retrospective study in a hospital electronic health records database

et al. 2018

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Summary What is known and Objective Hypersensitivity adverse drug reactions (HADRs) are associated with considerable morbidity and mortality. The aim of this study was to identify cases of HADRs within a hospital electronic health records (EHR) database. Methods Data were extracted from EHR through the Portuguese catalogue of allergies and other adverse reactions (CPARA). This registry allows the collection and sharing of information on HADRs in a structured and harmonized way across the healthcare system. This module is used by healthcare professionals to record HADRs within the EHR of each patient. It applies to patients admitted to hospital because of HADRs and also to inpatients developing such reactions during hospitalization. Data recorded from 2013 to 2017 within the Centro Hospitalar de Entre o Douro e Vouga (CHEDV) hospital (397 beds; ≈20 300 inpatients/year) were considered. The MedDRA® classification was used to codify HADRs. The ATC classification system was used to codify drugs. The concept of individual case safety report (ICSR) was considered for performing analyses. Results and discussion The database contained 464 valid cases (severe, n = 330; 71.1%), corresponding to 380 patients and 559 HADRs. Most patients were female (n = 254; 66.8%); the median age was 55 years. Approximately 0.1% local inhabitants and ≈0.4% inpatients have experienced HADRs over the study period. Most cases (n = 245; 52.8%) were associated with systemic antibacterials. Most HADRs were skin and subcutaneous tissue disorders (n = 266; 47.6%) and immune system disorders (n = 231; 41.3%). The pattern of suspected drugs implicated in anaphylactic reactions was the same as those involved in other HADRs. What is new and conclusion This registry contains HADRs that are relevant for the pharmacovigilance system, but none was spontaneously reported. The responsible authorities should address this problem. The results also reinforce the association between systemic antibacterials and HADRs.

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Section: Discussionsupporting

confidence: 84%

Section: The Overall 5-year Prevalence For Patients With Hypersensitimentioning

confidence: 99%

Drug-induced hypersensitivity: A 5-year retrospective study in a hospital electronic health records database

et al. 2018

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“…Recent data support the inclusion of anaphylaxis within the NIUA clinical entity [33]. In our study, 1 patient who presented with anaphylaxis has reacted to more than 1 NSAID.…”

Section: Discussionsupporting

confidence: 55%

Establishing a Safe Administration of ASA in Cardiovascular Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity with Skin and/or Respiratory Involvement

Al‐Ahmad

Rodriguez-Bouza

Nurkic

2018

Int Arch Allergy Immunol

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Background: A history of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity with cross-intolerance to several drugs is common in some patients with coronary artery disease. We present a series of patients with acute coronary syndrome undergoing ASA desensitization prior to a possible stent to evaluate the short- and long-term efficacy and safety. The aim was to evaluate the outcomes of an ASA desensitization protocol developed by our center based on the guidelines proposed by the EAACI drug allergy expert recommendations. Methods: We developed a desensitization protocol that was based on both the patient characteristics and onset of reaction after NSAIDs, including premedication with a leukotriene antagonist and the H1-antagonist antihistamine. The clinical entities were NSAID-induced urticaria and/or angioedema in the absence of chronic spontaneous urticaria (NIUA) and NSAID-exacerbated respiratory disease (NERD). Results: A total of 23 patients were challenged or desensitized with ASA: 19 NIUA and 4 NERD. All patients tolerated the protocol at the different times of 30, 45, 90, and 120 min. The dosages of oral ASA that were given included 10, 21, 41, 81, and 162 mg (cumulative dose 315 mg). One patient reacted during the procedure and 1 during follow-up. Symptoms were limited to the skin without manifestations in other organs. All patients tolerated the required dose of ASA within 30–120 min. Those requiring urgent catheterization were desensitized within 90 min. Conclusions: Our protocol addresses challenge or desensitization with the contribution of a specialist allergist. It provides an effective, dynamic, safe, and short administration of 81 mg or higher of ASA in patients with a history of NSAID hypersensitivity with skin involvement.

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“…NSAID‐induced delayed reactions (SNIDRs) are very rare both in adults and in children (Table ). Mild cutaneous reactions are maculopapular and fixed drug eruptions, and more severe ones are acute generalized exanthematous pustulosis, Stevens‐Johnson syndrome/toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS), which may be even life‐threatening.…”

Section: Epidemiology and Clinical Manifestations In Different Phenotmentioning

confidence: 99%

“…NSAIDs, as with all the other drugs, may be associated with several side effects, including drug hypersensitivity reactions (DHRs). In general, DHRs count for nearly 15% of all adverse reactions to drugs, and appear, after each exposure to the specific molecule . NSAIDs are among the most frequently reported drugs associated with hypersensitivity reactions, both in the adult and in the pediatric population .…”

Section: Introductionmentioning

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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Adverse and Hypersensitivity Reactions to Prescription Nonsteroidal Anti-Inflammatory Agents in a Large Health Care System

Cited by 60 publications

References 55 publications

Drug-induced hypersensitivity: A 5-year retrospective study in a hospital electronic health records database

Drug-induced hypersensitivity: A 5-year retrospective study in a hospital electronic health records database

Establishing a Safe Administration of ASA in Cardiovascular Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity with Skin and/or Respiratory Involvement

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

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