Provocation tests with the offending nonsteroidal anti-inflammatory drugs in patients with urticaria/angioedema reactions

Zisa, Giuliana; F, Riccobono; Bommarito, Luisa; D’Antonio, Chiara; Am, Calamari; Poppa, M; Ma, Moschella; Pietrantonj, Carlo Di; Galimberti, M

doi:10.2500/aap.2012.33.3590

Cited by 13 publications

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“…15,17 However, this association was not found by other authors. 4,14 In our study, patients with confirmed NSAID-H presented a higher frequency of asthma and rhinitis than patients with excluded NSAID-H. Almost half (44.5%) of our patients were atopic.…”

Section: Discussionmentioning

confidence: 50%

“…The low frequency of confirmed diagnosis has been reported by other authors, suggesting that even in patients with a history of urticaria/angio-oedema, the diagnostic procedure could safely start with the offending NSAID. 14 Anaphylaxis is usually considered a contraindication for DPT because of the risk associated. In the work of Zambonino et al 1 the DPT with the culprit drug was not performed in patients who reported anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

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Non-steroidal anti-inflammatory drug hypersensitivity in children

Alves

Romeira

Abreu

et al. 2017

Allergologia et Immunopathologia

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Introduction: There are rather few publications about hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAID) in the paediatric age. In this study, we aimed to assess the frequency of confirmed NSAID hypersensitivity in children with a previous reported reaction to NSAID in order to investigate the role of the drug provocation test (DPT) in the diagnostic workup and to explore the factors associated with confirmed NSAID hypersensitivity. Methods: We conducted a retrospective analysis of the clinical files from every patient under 18 years old who attended two Portuguese paediatric allergy outpatient clinics, from January 2009 to August 2014, due to a suspected NSAID hypersensitivity. Results: We included 119 patients, with a median age of nine years (P 25 ---P 75 : 5---14). Ibuprofen was the commonest implicated NSAID in the patients' reports (n = 94---79%). After DPT, NSAID hypersensitivity was confirmed in nine (7.6%) patients, excluded in 93 (78.2%) and was inconclusive in 17 (14.3%). In the majority (n = 95---79.8%), the reaction occurred in the first 24 h after intake. Eighty-four patients (70.6%) reported only cutaneous manifestations and 18 (15.1%) had systemic symptoms. Anaphylaxis represented a relative risk to NSAID hypersensitivity confirmation. No association was found for atopy and the number of previous reactions. Conclusion: In our study, NSAID hypersensitivity was confirmed in a small proportion of the patients with a previous reported reaction. Ibuprofen was the most implicated drug with urticaria/angio-oedema as the commonest manifestation. Anaphylaxis was associated with confirmed drug hypersensitivity. The drug provocation test was essential to establish the diagnosis.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Non-steroidal anti-inflammatory drug hypersensitivity in children

Alves

Romeira

Abreu

et al. 2017

Allergologia et Immunopathologia

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“…Indeed, several studies showed that the majority of patients with a convincing history of NSAID hypersensitivity were actually NSAID-tolerant. In a study by Zisa et al of 159 patients with a clinical history of urticaria/angioedema apparently related to NSAIDs, only 10.7% were positive on the OPT with the suspected drugs (22). Half of these were single-NSAID reactors.…”

Section: Discussionmentioning

confidence: 96%

Predictive value of a negative oral provocation test in patients with hypersensitivity to analgesics

Jakič

Jager

Košnik

2016

Acta Dermatovenerologica Alpina Pannonica Et Adriatica

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Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) take first or second place as the cause of drug-induced hypersensitivity reactions. The oral provocation test (OPT) is a gold standard for the diagnosis of NSAID hypersensitivity. We investigated which analgesics patients took after a negative OPT and determined the proportion of patients that experienced a hypersensitivity reaction despite a negative OPT. Methods: We selected 115 patients (67.8% female, age 54.9 ± 16.7 years) with a negative aspirin OPT and a convincing history of immediate hypersensitivity to aspirin or NSAIDs. In a telephone survey, we identified the analgesics taken after the OPT and possible adverse events. Results: The mean follow-up time was 5.1 ± 2.0 years. All subjects needed at least one analgesic drug. Despite the negative outcome of the aspirin OPT, only 33.9% of subjects took aspirin and 0.9% had a hypersensitivity reaction. The negative predictive value (NPV) of the aspirin OPT was 97.4%. Overall, 16 (13.9%) subjects experienced a hypersensitivity reaction, 12 of which occurred after taking a drug not tested with the OPT. The NPV of the OPT for all NSAIDs was 96.4%. Conclusion: Our results support the available data that most subjects do not re-take the tested drug regardless of the high NPV of the OPT.

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“…Pérez-Alzate et al included 697 patients with confirmed NSAID hypersensitivity, 203 of them with SNIUAA (8). An Italian study included 159 patients with NSAID hypersensitivity, but only those with urticarial or angioedema reaction (12), and Danish studies included 147 patients with a reaction after ingestion of NSAID (13). Our cohort is relatively large compared to other studies, with 2,090 patients included who had an OPT between 2004 and 2016.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have shown that a diagnostic procedure in patients with SNIUAA should begin with aspirin OPT (2,11,12). This procedure enables separation of the cross-reactors from patients with selective hypersensitivity and prevent patients from unnecessarily avoiding a large group of analgesics.…”

Section: Discussionmentioning

confidence: 99%

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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Provocation tests with the offending nonsteroidal anti-inflammatory drugs in patients with urticaria/angioedema reactions

Cited by 13 publications

References 0 publications

Non-steroidal anti-inflammatory drug hypersensitivity in children

Non-steroidal anti-inflammatory drug hypersensitivity in children

Predictive value of a negative oral provocation test in patients with hypersensitivity to analgesics

Selective hypersensitivity to a single nonsteroidal anti-inflammatory drug

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