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

Pérez-Alzate, Diana; Cornejo-García, José Antonio; Pérez‐Sánchez, Natalia; Andreu, Inmaculada; García‐Moral, Alba; Agúndez, JA; Bartra, Joan; Doña, Inmaculada; Torres, M.J.; Blanca, Miguel; Blanca‐López, Natalia; Cantó, Gabriela

doi:10.18176/jiaci.0080

Cited by 25 publications

(32 citation statements)

References 33 publications

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“…Despite the high prevalence of hypersensitivity to NSAID and the importance of determining the phenotypes, there is very little literature on this subject to enable comprehensive comparison of our data. A study by Pérez-Alzate et al showed that in some countries cross-hypersensitivity is more common whereas in others selective hypersensitivity dominates (8). In our study, among 559 patients whose diagnosis of hypersensitivity to analgesic was certain, 44.3% patients had anaphylaxis or urticaria after a single analgesic.…”

Section: Discussionsupporting

confidence: 45%

Selective hypersensitivity to a single nonsteroidal anti-inflammatory drug

Klar

Sotošek

Šelb

et al. 2019

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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Introduction: The aim of the study was to explore the frequency and the clinical and diagnostic characteristics of a single nonsteroidal anti-inflammatory drug-induced hypersensitivity (SNIUAA) subgroup. Methods: In the hospital information system we identified patients who performed the oral provocation test (OPT) with analgesics between 2004 and 2016. We divided patients into phenotype groups based on clinical history and OPT results. Results: Altogether, 248 patients (44.3% of phenotyped patients) were diagnosed with SNIUAA. The most common offending drug in SNIUAA was diclofenac (52.4%), followed by pyrazolones (30.7%). In the group with selective diclofenac hypersensitivity, there was a larger percentage (40.0%) of patients with anaphylaxis. Compared to other phenotypes, significantly fewer patients had OPT performed with the suspected drug in SINUAA; however, in 69.4% of patients in this group, OPT with acetylsalicylic acid was performed. Conclusions: SNIUAA was the most common phenotype of nonsteroidal anti-inflammatory drug hypersensitivity in our cohort. Diclofenac was the most common cause of the hypersensitivity reaction and also the most common cause of anaphylactic reaction. In the group of patients with a positive history after taking diclofenac or pyrazolone, fewer OPTs with the suspected drug were performed, but more often OPT with aspirin to prove that hypersensitivity is selective.

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Section: Discussionsupporting

confidence: 45%

Selective hypersensitivity to a single nonsteroidal anti-inflammatory drug

Klar

Sotošek

Šelb

et al. 2019

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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“…Aspirin was shown to be tolerated in a group of patients with actual immediate-type selective responses to more than one chemically different NSAIDs, and the cross-reactivities were confirmed with either skin tests, basophil activation tests, or OPTs with the culprit. 22,56 This phenotype has not been described in children until now.…”

Section: Epidemi Ology and Clinic Al Manife S Tations In D Ifferentmentioning

confidence: 99%

“…Cross‐reactivities were defined to ibuprofen, dexketoprofen, and/or naproxen in some of the participants, which were referred as selective IgE‐mediated reactions . However in a recent study, it was proven that patients with a history of immediate reaction to more than one chemically different NSAIDs may also show selective responses and cross‐hypersensitivity to culprit NSAIDs since they tolerate ASA . The selective but non‐immediate or “delayed”‐type reactions appear usually 24 hours after the initial NSAID intake, and may be characterized by maculopapular exanthema, by eczema, or by even more severe forms, including fixed drug eruptions, toxic epidermal necrolysis, or organ‐related reactions .…”

Section: Mechanisms Of Nsaid Hypersensitivitymentioning

confidence: 99%

“…20 However in a recent study, it was proven that patients with a history of immediate reaction to more than one chemically different NSAIDs may also show selective responses and cross-hypersensitivity to culprit NSAIDs since they tolerate ASA. 22 The selective but non-immediate or "delayed"-type reactions appear usually 24 hours after the initial NSAID intake, and may be characterized by maculopapular exanthema, by eczema, or by even more severe forms, including fixed drug eruptions, toxic epidermal necrolysis, or organ-related reactions. 18 Three different groups of cross-intolerant reactions are listed in the current international classification: NSAID-exacerbated respiratory disease (NERD), NSAID-exacerbated cutaneous disease (NECD), and NSAID-induced urticaria and/or angioedema (NIUA).…”

Section: Mechanis Ms Of N Said Hyper S En S Itivit Ymentioning

confidence: 99%

See 1 more Smart Citation

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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“…As with BLs, standardization of DPTs is required concerning number of doses, the optimal dose itself, length, and type of NSAID challenged. Some authors propose a direct DPT with the culprit NSAID [38,39,41], whereas others start with aspirin to exclude cross-intolerance [37,42]. Starting with aspirin is beneficial since it can help distinguish selective and cross responders with one single DPT.…”

mentioning

confidence: 99%