Two approaches for diagnosis of nonsteroidal anti-inflammatory drug hypersensitivity in children.

Abstract

BACKGROUND:

The oral provocation test (OPT) with culprit drug is the gold standard in the diagnosis of nonsteroidal anti-inflammatory drug hypersensitivity (NSAID-H). Some authors have proposed that the total number of OPTs required to diagnose NSAID-H is much lower with acetyl salicylic acid (ASA) provocations, regardless of patients' reaction history, and less time consuming.

OBJECTIVE:

This study aims to evaluate the total number of OPTs required to confirm NSAID-H according to the drugs (ASA or culprit NSAID) used in the initial OPT.

METHODS:

The study included patients with a history of NSAID-H. Data on the demographic and clinical features, coexisting chronic or allergic disease, and laboratory results were collected from medical records. The drug used for the initial OPT (ASA or culprit NSAID), results of the OPT, and the total number of OPTs were reviewed.

RESULTS:

We included 56 children with suspected hypersensitivity reaction to NSAIDs. NSAID-H was confirmed in 21 children (37.5%). We calculated that if all OPTs were performed with culprit drugs as an initial choice, the number of OPTs required for diagnosis would be 3 or more in 85.7% of positive cases. The number of episodes was an independent risk factor for NSAID-H by multiple logistic regression analysis (odds ratio, 4.3; 95% confidence interval, 1.48-12.24; P = .007).

CONCLUSION:

Performing an initial OPT with ASA regardless of patients' reaction history can result in much lower numbers of OPT to diagnose NSAID-H and can improve patient compliance.

• Authors: Isil Eser Simsek, Mujde Tuba Cogurlu, Metin Aydogan
• Journal: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (Ann Allergy Asthma Immunol) Vol. 123 Issue 4 Pg. 389-393 (10 2019) ISSN: 1534-4436 [Electronic] United States
• PMID: 31323315 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Aspirin

Topics

• Adolescent
• Anti-Inflammatory Agents, Non-Steroidal (immunology)
• Aspirin (immunology)
• Child
• Child, Preschool
• Drug Hypersensitivity (diagnosis, immunology)
• Female
• Humans
• Infant
• Logistic Models
• Male
• Multivariate Analysis
• Skin Tests (methods)