Diagnosis of Pyrazolone Drug Sensitivity: Clinical History Versus Skin Testing and In Vitro Testing

Kowalski, Marek L.; Bieńkiewicz, Barbara; Woszczek, Grzegorz; Iwaszkiewicz, Jolanta; Poniatowska, Marita

doi:10.2500/108854199778251799

Cited by 43 publications

(42 citation statements)

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“…Another drug of interest was metamizole, a frequent elicitor of SRs [9,35] in countries where it is still widely prescribed [1,8,10]. In our study, positive skin test or BAT results became negative over time, as usually occurs in IgEmediated responses to drugs [27].…”

Section: Discussionmentioning

confidence: 62%

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Pérez-Alzate

Cornejo-García

Pérez‐Sánchez

et al. 2017

J Investig Allergol Clin Immunol

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Background: Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors. Methods: Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration. Results: From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients. Conclusions: Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.

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Section: Discussionmentioning

confidence: 62%

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Pérez-Alzate

Cornejo-García

Pérez‐Sánchez

et al. 2017

J Investig Allergol Clin Immunol

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“…Anaphylactic shock was observed in 18-30% of patients hypersensitive to pyrazolones (e.g. metamizole) (67,68). Other symptoms, such as generalized pruritus, rhinitis, and bronchospasm, may also be present in some patients.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Skin prick and intradermal tests with different dilutions of noraminophenazone, propyphenazone or aminophenazone were used in patients with suspected pyrazolone hypersensitivity (67,68). The diagnosis of propyphenazone allergy could be confirmed with the combination of skin prick tests and intradermal skin test in the majority of the patients (68).…”

Section: Skin Testingmentioning

confidence: 99%

“…Both skin swelling and mucosal (laryngeal) angioe-dema may be present, and progression of these reactions to anaphylactic shock and death has been described (67,68). Anaphylactic shock was observed in 18-30% of patients hypersensitive to pyrazolones (e.g.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…The NSAIDs most frequently reported to induce this type of reaction are pyrazolones (67,68), paracetamol, ibuprofen, diclofenac and naproxen. The data from Netherlands (years 1974-1994) showed that NSAIDs which most frequently caused anaphylaxis were glafenine (withdrawn from the market for this reason), pyrazolones, diclofenac and ibuprofen (70).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

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Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA# and GA2LEN/HANNA*

Kowalski

Makowska

Blanca³

et al. 2011

Allergy

393

366

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Following the first description of hypersensitivity reaction to aspirin (ASA) by Hirschberg in 1902, several types of hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) have been described. The NSAIDs-induced hypersensitivity reactions involve different mechanisms and present a wide range of clinical manifestations from anaphylaxis AbstractNonsteroidal anti-inflammatory drugs (NSAIDs) are responsible for 21-25% of reported adverse drug events which include immunological and nonimmunological hypersensitivity reactions. This study presents up-to-date information on pathomechanisms, clinical spectrum, diagnostic tools and management of hypersensitivity reactions to NSAIDs. Clinically, NSAID hypersensitivity is particularly manifested by bronchial asthma, rhinosinusitis, anaphylaxis or urticaria and variety of late cutaneous and organ-specific reactions. Diagnosis of hypersensitivity to a NSAID includes understanding of the underlying mechanism and is necessary for prevention and management. A stepwise approach to the diagnosis of hypersensitivity to NSAIDs is proposed, including clinical history, in vitro testing and/ or provocation test with a culprit or alternative drug depending on the type of the reaction. The diagnostic process should result in providing the patient with written information both on forbidden and on alternative drugs.

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Basophil activation after nonsteroidal anti‐inflammatory drugs stimulation in patients with immediate hypersensitivity reactions to these drugs

et al. 2014

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are the drugs most frequently involved in allergic reactions of which two main types exist: IgE-mediated and crossintolerance. The diagnosis of crossintolerance reactions is often based on the drug provocation test. The potential value of the basophil activation test (BAT) was evaluated using different basophil markers in the diagnosis of patients with crossintolerance to NSAIDs and cutaneous symptoms. We studied 46 patients with crossintolerance to NSAIDs and 45 tolerant controls. BAT was performed with acetyl salicylic acid, paracetamol, diclofenac, dipyrone, naproxen, and ibuprofen at four different concentrations using CD193 and CD203c as basophil markers and CD63 as activation marker. We compared BAT results using CD193 1 or CD193 1 CD203c 1 for basophil selection and found a significant increase in the stimulation index when using CD193 1 CD203c 1 in both patients and controls (P 5 0.004 and P 5 0.017, respectively). Selection of living cells only produced an increase in basophil stimulation in patients for both CD193 1 and CD193 1 CD203c 1 (P < 0.001 for both), whereas in controls there was no change with CD193 1 and a decrease with CD193 1 CD203c 1 (P 5 0.001). We found that CD193 1 CD203c 1 increased the percentage of positive cases in patients and controls when compared with CD193 1 . When excluding dead cells, there was an increase of 21.7% in patients and 10% in controls. These results indicate that using CD193 1 CD203 1 , excluding dead cells, is the best approach for BAT although this test is not recommended for the diagnosis of patients with crossintolerance to NSAIDs owing to its low sensitivity and specificity. V C 2014 International Society for Advancement of Cytometry Key terms hypersensitivity; nonsteroidal anti-inflammatory drugs; idiosyncratic reactions; basophils; CD63; CD193; CD203c NONSTEROIDAL anti-inflammatory drugs (NSAIDs) are the drugs most frequently involved in immediate or acute hypersensitivity reactions, accounting for 20-25% of patients evaluated in allergy units, with two main mechanisms involved (1-3). One is mediated by drug-specific-IgE antibodies and reactions occur with one NSAID but there is tolerance to other nonchemically related drugs (4,5). These reactions are known as single NSAID induced hypersensitivity reactions and involve NSAIDs such as paracetamol (6), acetyl salicylic acid (ASA) (7), diclofenac (8), ketorolac (9), dipyrone (10,11), and cyclooxygenase-2 selective inhibitors (COX-2) (12). The other type of reaction is mediated by a pharmacological mechanism in which the inhibition of cyclooxygenase-1 enzyme (COX-1) leads to a decrease in the synthesis of prostaglandin E 2, which in turn hampers the production of sulphidoleukotrienes

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Diagnosis of Pyrazolone Drug Sensitivity: Clinical History Versus Skin Testing and In Vitro Testing

Cited by 43 publications

References 1 publication

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified

Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA# and GA2LEN/HANNA*

Basophil activation after nonsteroidal anti‐inflammatory drugs stimulation in patients with immediate hypersensitivity reactions to these drugs

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