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Oral aspirin challenges in patients with a history of intolerance to single non-steroidal anti-inflammatory drugs.

AbstractUNLABELLED:
Summary Background In the clinical practice patients with a history of acute urticaria induced by a single non-steroidal anti-inflammatory drug (NSAID) and seeking for safe alternative drugs generally undergo tolerance tests with alternative NSAIDs that have little or no cyclooxygenase-1 (COX-1) enzyme inhibitory activity. This practice does not allow for the detection of single NSAID reactors and may lead to unnecessary avoidance of many potentially useful NSAIDs.
OBJECTIVE:
Evaluate aspirin challenge as a means to distinguish single from multiple NSAID intolerance in patients with a clinical history of acute urticaria induced by a single NSAID. Methods One hundred and seventeen otherwise normal subjects with a history of acute urticaria following the ingestion of a single NSAID (pyrazolones (n=58), nimesulide (n=17), propionic acid derivatives (n=13), aryl acetic acid derivatives (n=14), acetaminophen (n=9), piroxicam (n=5), and indometacin (n=1)) underwent single-blind placebo-controlled oral challenges with aspirin. Aspirin-intolerant subjects underwent further tolerance tests drugs exerting little or no inhibitory activity on COX-1 enzyme (including paracetamol, nimesulide, rofecoxib, tramadol, and floctafenine). Results Aspirin induced urticaria in 28/117 (24%) patients. Five out of 28 (18%) aspirin reactors did not tolerate alternative NSAID on subsequent oral challenges. Conclusion In subjects with a history of urticaria induced by a single NSAID (other than aspirin) the diagnostic workup should start with an aspirin challenge in order to detect single/multiple NSAID reactors.
AuthorsR Asero
JournalClinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology (Clin Exp Allergy) Vol. 35 Issue 6 Pg. 713-6 (Jun 2005) ISSN: 0954-7894 [Print] England
PMID15969659 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Analgesics
  • Anti-Inflammatory Agents, Non-Steroidal
  • Cyclooxygenase Inhibitors
  • Lactones
  • Sulfonamides
  • Sulfones
  • ortho-Aminobenzoates
  • rofecoxib
  • Acetaminophen
  • Tramadol
  • floctafenine
  • Aspirin
  • nimesulide
Topics
  • Acetaminophen (administration & dosage, adverse effects)
  • Acute Disease
  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics (administration & dosage, adverse effects)
  • Anti-Inflammatory Agents, Non-Steroidal (administration & dosage, adverse effects)
  • Aspirin (administration & dosage, adverse effects)
  • Child
  • Cyclooxygenase Inhibitors (administration & dosage, adverse effects)
  • Drug Evaluation
  • Female
  • Humans
  • Lactones (administration & dosage, adverse effects)
  • Male
  • Middle Aged
  • Recurrence
  • Single-Blind Method
  • Sulfonamides (administration & dosage, adverse effects)
  • Sulfones (administration & dosage, adverse effects)
  • Tramadol (administration & dosage, adverse effects)
  • Urticaria (chemically induced, immunology)
  • ortho-Aminobenzoates (administration & dosage, adverse effects)

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