Nonsteroidal Anti-Inflammatory Drug Hypersensitivity in Preschool Children

Abstract

Although extensively studied in adults, nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity in children, especially in young children, remains poorly defined. Pediatricians, prescribing antipyretics for children, rarely encounter significant problems, but the few epidemiologic studies performed show conflicting results. Although it is clear that some patients with acetylsalicylic acid (ASA)-sensitive asthma have their clinical onset of disease in childhood and bronchoconstriction after ASA challenge is seen in 0 to 22% of asthmatic children so challenged, ibuprofen at antipyretic doses may cause acute respiratory problems only in a very small number of mild to moderate asthmatics. The recently elucidated mechanism of action of acetaminophen may explain some occurrences of adverse reactions in patients with cross-reactive NSAID hypersensitivity on the basis of its inhibitory activity on the newly described enzyme, cyclooxygenase (COX)-3. This nonspecific sensitivity to inhibition of COX is most likely genetically determined and shows a remarkable association with atopic disease even in the very young age group and possibly an increased predilection in specific ethnic groups. This review summarizes state-of-the-art published data on NSAID hypersensitivity in preschool children.

Prevalence of Hypersensitivity Reactions in Children Associated with Acetaminophen: A Systematic Review and Meta-Analysis

“…1). The 85 remaining articles [3, 9, 13-21, 24-97] were included in the qualitative analysis (online suppl. Table S1; for all online suppl.…”

“…Although hepatotoxicity related to acetaminophen overdosing has been well documented [2], acetaminophen hypersensitivity is a rare event [3], and very little is known about the hypersensitivity reactions related to appropriate dosing. Most reported cases of hypersensitivity reactions to acetaminophen involve the skin, including nonimmediate cutaneous eruptions [4], fixed drug eruptions [5], Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) [6, 7], and anaphylaxis [8].…”

“…The reaction is T cell-mediated and usually manifests as a delayed cutaneous reaction, but may have various clinical presentations [9]. Reactions to acetaminophen are reported mostly in association with suspected reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) [3, 4]. Given that there are no validated skin tests, establishing the diagnosis of acetaminophen hypersensitivity relies completely on conducting oral challenges [10, 11].…”

Natural evolution in patients with nonsteroidal anti‐inflammatory drug‐induced urticaria/angioedema

“…Isolated urticaria is the most frequent clinical condition in adults, 6 and facial and lip angioedema in children. [9][10][11] Few prospective studies have been carried out to analyze the natural history of NIUA. It has been reported that up to one in three patients with NIUA develop CSU over time suggesting that NIUA may therefore precede CSU.…”

Nonsteroidal anti-inflammatory drug (NSAID) associated fixed drug eruption (FDE) in children attending dermatology OPD of a tertiary care hospital of Eastern India: a cross-sectional observational study

“…This blockade also results in the shunting of arachidonic acid toward the 5-lipoxigenase pathway, resulting in increased production and release of cysteinyl leukotrienes. 4 This article attempts to provide a close insight into the incidence of fixed drug eruptions that occur in the pediatric age group yet remain unreported. It is widely felt that active drug surveillance is of utmost significance in order to capture risk information of drugs being used in children.…”