Challenge-proven aspirin hypersensitivity in children with chronic spontaneous urticaria

Cavkaytar, Özlem; Yılmaz, Ebru; Büyüktiryaki, Betül; Şekerel, Bülent Enis; Saçkesen, Cansın

doi:10.1111/all.12539

Cited by 31 publications

(25 citation statements)

References 34 publications

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“…This phenotype was previously defined as 'aspirin-exacerbated cutaneous disease' (AECD) [38] , which is now known as NECD [10] . In our previous study, in which AECD was defined in a group of children and adolescents with CSU, 1 of the children exhibited bronchospasm upon the administration of aspirin during an OPT, although all the other participants had apparent angioedema and/or exacerbation of urticarial lesions [24] . Respiratory involvement may be a feature of NSAID-hypersensitive children with concurrent CSU.…”

Section: Discussionmentioning

confidence: 99%

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Different Phenotypes of Non-Steroidal Anti-Inflammatory Drug Hypersensitivity during Childhood

Cavkaytar

Yılmaz

Karaatmaca

et al. 2015

Int Arch Allergy Immunol

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Background: Although non-steroidal anti-inflammatory drug hypersensitivity (NSAID-H) has been widely studied in adults, there is still a lack of data regarding the features and phenotypes of NSAID-H in children. Our aim was to define risk factors and different phenotypes according to clinical patterns. Methods: Patients with a history of reaction to any NSAIDs referred between January 2012 and October 2014 were included. After completing a European Network for Drug Allergy (ENDA) questionnaire, initial skin and/or oral provocation tests (OPTs) were performed for the offending drug. Additional OPTs were done with aspirin in case of NSAID-H to determine cross-reactivity. NSAID-hypersensitive patients were defined as being either a selective responder (SR) or cross-intolerant (CI) and further categorized according to either the ENDA/GA²LEN classification or an alternative scheme by Caimmi et al. [Int Arch Allergy Immunol 2012;159:306-312]. Results: Among 121 patients [58.7% male, average age 7.8 years (4.7-10.8)] with 161 NSAID-related reactions, 110 patients with 148 reactions were assessed. NSAID-H was diagnosed in 30 (27%) patients with 37 (25%) reactions. Multivariate regression analysis revealed that an immediate-type reaction and respiratory symptoms during the reaction increased the risk of a reproducible NSAID-related reaction (OR 3.508, 95% CI 1.42-8.7, p = 0.007; OR 3.951, 95% CI 1.33-11.77, p = 0.014, respectively). Additional OPTs revealed 13 SRs and 14 CIs. A family history of allergic disease was more frequent in CIs compared to SRs (57.1 vs. 15.4%, p = 0.031). Reactions belonging to CIs were more frequently characterized by angioedema compared to those of SRs (81.3 vs. 46.2%, p = 0.019). SRs and CIs were further classified as single NSAID-induced urticaria/angioedema and/or anaphylaxis (n = 13), NSAID-induced urticaria/angioedema (n = 7), NSAID-exacerbated cutaneous disease (n = 2) and NSAID-exacerbated respiratory disease (n = 1). Four CIs could not be categorized according to either classification system. One SR could not be categorized according to ENDA/GA²LEN. Conclusion: During childhood, NSAID-H exhibits different phenotypes and the majority of them can be categorized with current classification systems; however, classifications based on adult data may not exactly fit NSAID-H in paediatric patients.

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Section: Discussionmentioning

confidence: 99%

“…Patients were followed up for 6 h after the end of the OPTs. The patients and their parents were informed about the symptoms of a positive OPT and after the 6-hour follow-up period they were advised to call and readmit for an additional 48 h in the event of the occurrence of possible allergic symptoms, as previously described [24] .…”

Section: Opts With Nsaidsmentioning

confidence: 99%

Different Phenotypes of Non-Steroidal Anti-Inflammatory Drug Hypersensitivity during Childhood

Cavkaytar

Yılmaz

Karaatmaca

et al. 2015

Int Arch Allergy Immunol

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“…Acute urticaria is more prevalent than chronic urticaria; however, chronic urticaria has a more significant impact on quality of life due to recurrence and unknown etiology 1. As in adults, the causes are different between acute and chronic urticaria in children,2345678 and it is difficult to determine the exact prevalence of childhood urticaria due to lack of papulation-based studies.…”

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confidence: 99%

“…In recent studies, more than 30% of children with chronic urticaria are classified as chronic autoimmune urticaria 56. Even though the prevalence is lower in children than in adults, nonsteroidal anti-inflammatory drugs are identified as major aggravating factors of chronic spontaneous urticaria in children 78. In the very recent studies of adults with chronic urticaria, serum vitamin D levels were likely to be lower and showed significant negative associations with urticaria activity score and duration 910.…”

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confidence: 99%

Prevalence and Causes of Childhood Urticaria

Shin

Lee

2017

Allergy Asthma Immunol Res

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“…Nonsteroidal anti-inflammatory drugs (NSAIDs), penicillin and sulfonamide may cause chronic urticaria. One recent study found the NSAIDs and chronic urticaria in children and reported that 10% to 24% children with chronic urticaria have aspirin hypersensitivity [15].…”

Section: Drugsmentioning

confidence: 99%

Chronic Urticaria in Children: An Update about Etiology

Meena¹

2017

MOJI

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Urticaria, one of the most common dermatological disorders across the globe is characterized by itchy wheels with or without angioedema. The incidence of Urticaria in children is about 0.1% to 6% Chronic Urticaria is defined as a daily occurrence of spontaneous wheals, angioedema, or both for >6 weeks. The etiology of chronic Urticaria is multifactorial in children and it can be explored in 20% to 50% children. In most of children the cause of chronic Urticaria are either idiopathic or autoimmune.

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Challenge-proven aspirin hypersensitivity in children with chronic spontaneous urticaria

Abstract: Nearly a quarter of children and adolescents with CSU were hypersensitive to aspirin. For children with chronic urticaria, determination of NSAID hypersensitivity in a well-controlled clinical setting will help to avoid severe drug hypersensitivity reactions.

Cited by 31 publications

References 34 publications

Different Phenotypes of Non-Steroidal Anti-Inflammatory Drug Hypersensitivity during Childhood

Different Phenotypes of Non-Steroidal Anti-Inflammatory Drug Hypersensitivity during Childhood

Prevalence and Causes of Childhood Urticaria

Chronic Urticaria in Children: An Update about Etiology

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