Retrospective evaluation of children with non-steroidal anti-inflammatory drug allergy

Year 2023, Volume: 6 Issue: 2, 215 - 219, 31.08.2023

Ayşe Aydoğdu , Nurullah Yekta Akçam

https://doi.org/10.36516/jocass.1246401

Abstract

Aim: Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs and are among the drug-related hypersensitivity reactions after antibiotics. There are limited studies evaluating nonsteroidal drug reactions in children. In this study, we aimed to evaluate the concomitant atopic diseases, admission clinic, laboratory findings and drug provocation test results of children with a pre-diagnosis of nonsteroidal drug reaction and who underwent allergy tests, retrospectively .
Methods: In this study, patients who applied to the pediatric allergy outpatient clinic due to nonsteroidal drug reaction were included. In this group of patients, age, gender, fx5 (nutrient mix specific IgE), phadiatop (inhalant allergen mix specific IgE), skin prick tests and drug provocation tests were recorded from their files. Demographic and clinical features of the cases were compared.
Results: 61 patients with suspected NSAIDs allergy were included in the study. When the admission clinics of the patients were evaluated, 54% (n:33) had urticaria, 22.9% (n:14) had isolated angioedema, 6.5% (n:4) had urticaria angioedema, 14.7% (n:9) had maculopapular eruption . Only 1 patient presented with anaphylaxis. NSAIDs allergy was confirmed in 16.3% (n:10) of the patients.. Single ibuprofen sensitivity was detected in 13.1% of patients (n:8), both paracetamol and ibuprofen sensitivity were detected in 1 patient (1.6%), and single paracetamol sensitivity was detected in 1 patient (1.6%).
Conclusions: It is usually not easy to detect drug allergies in patients. These patients may usually misdiagnosed as NSAIDs allergy. In our study, it was revealed that drug provocation tests should be performed to confirm the diagnosis in case of suspected NSAIDs allergy.

Keywords

Non-steroidal anti-inflammatory drug allergy, isolated angioedema, drug provocation test

Non-steroidal antiinflamatuar ilaç alerjisi olan çocukların retrospektif değerlendirilmesi

Abstract

Özet

Amaç: Non-steroidal antiinflamatuar ilaçlar (NSAİİ), sık kullanılan ilaçlar arasındadır ve ilaç ilişkili aşırı duyarlılık reaksiyonları arasında antibiyotiklerden sonra yer almaktadır. Çocuklarda nonsteroid ilaç reaksiyonlarının değerlendirildiği sınırlı sayıda çalışma vardır. Bu çalışmada nonsteroid ilaç reaksiyonu ön tanısı ile gelen ve alerji testleri yapılan çocukların eşlik eden atopik hastalıklar, başvuru kliniği, laboratuvar bulgularının ve ilaç provokasyon testi sonuçlarının retrospektif olarak değerlendirilmesi amaçlandı.
Yöntem: Bu çalışmada çocuk alerji polikliniğine nonsteroid ilaç reaksiyonu nedeniyle başvuran hastalar alınmıştır. Bu gruptaki hastalarda yaş, cinsiyet, fx5 ( besin mix spesifik IgE), phadiatop (inhalan alerjen mix spesifik IgE), deri prick testleri ve ilaç provokasyon testleri bilgileri dosyalarından alınarak kaydedildi. Olguların demografik ve klinik özellikleri karşılaştırıldı.
Bulgular: NSAİİ allerjisi şüphesi olan 61 hasta çalışmaya dahil edildi. Hastaların başvuru klinikleri değerlendirildiğinde %54 (n:33)’ünün ürtiker, %22.9 (n:14)’unun izole anjioödem, %6.5 (n:4)’ uğunun ürtiker anjioödem, %14.7 (n:9)’sinin ise makülopapüler erupsiyon nedeniyle başvurdukları görüldü. Sadece 1 hasta anafilaksi ile başvurmuştu. Hastaların %16.3 (n:10)’ ünde NSAİİ alerjisi doğrulandı. Hastaların %13. 1(n:8)’inde tekli ibuprofen duyarlılığı tespit edilirken, 1 hastada (%1.6) hem parasetamol hem de ibuprofen duyarlılığı, 1 hastada (%1.6) parasetamol duyarlılığı tespit edildi.
Sonuç: Hastalarda ilaç alerjisinin tespit edilmesi genellikle çok kolay olmamaktadır. Bu hastalar sıklıkla yanlış olarak ilaç alerjisi tanısı alabilmektedir. Çalışmamızda NSAİİ alerjisi şüphesi durumunda tanıyı doğrulamak için ilaç provokasyon testlerinin yapılması gerektiği ortaya konulmuştur.

Keywords

Non-steroidal antiinflamatuar ilaç alerjisi, izole anjioödem, ilaç provokasyon testi, Non-steroidal antiinflamatuar ilaç alerjisi, izole anjioödem, ilaç provokasyon testi

References

• 1-Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization. J Allergy Clin Immunol 2004
• 2- Waheed A., Hill T., Dhawan N. Drug Allergy (2016) Primary Care 2016 Sep;43(3):393-400
• 3- Dykewicz M.S., Lam J.K. Drug Hypersensitivity Reactions Medical Clinics of North America, 2020 Jan;104(1):109-128.
• 4-Demoly P, Bousquet J. Epidemiology of drug allergy. Curr Opin Allergy Clin Immunol 2001;1:305-10
• 5-Impicciatore P, Choonara I, Clarkson A, Provasi D, Pandolfini C, Bonati M. Incidence of adverse drug reactions in paediatric in/outpatients: a systematic review and meta-analysis of prospective studies. Br j Clin Pharmacol. 2001;52(1):77-83.)
• 6-Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Current opinion in allergy and clinical immunology 2005;5(4):309-316.
• 7-Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000 Oct 7;356(9237):1255-9.
• 8-Zambonino M.A , Torres M.J, Muñoz et al.Drug provocation tests in the diagnosis of hypersensitivity reactions to non-steroidal anti-inflammatory drugs in children Pediatr Allergy Immunol 2013 Mar;24(2):151-9.
• 9-Kowalski ML, Asero R, Bavbek S, et al. Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal antiinflammatory drugs. Allergy. 2013 Oct;68(10):1219-32
• 10-Weiland SK, Björkstén B, Brunekreef B,et al. Phase II of the International Study of Asthma and Allergies in Childhood (ISAAC II): Rationale and methods. Eur Respir J 2004;24:406-12.
• 11- Aberer W.,Bircher A., Romano A.et al.Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations Allergy 2003 Sep;58(9):854-63.
• 12- Atanaskovic-Markovic M , Blanca-Lopez N. , Gomes E. et al. A Multicenter Retrospective Study on Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Children: A Report from the European Network on Drug Allergy (ENDA) Group Journal of Allergy and Clinical Immunology: In Practice, 2020-03-01, Volume 8, Issue 3, Pages 1022-1031.e1 ) 13-Renaudin JM, Beaudouin E, Ponvert C, et al. Severe drug-induced anaphylaxis: analysis of 333 cases recorded by the Allergy Vigilance Network from 2002 to 2010. Allergy, 2013;68(7), 929–937.
• 14-Ribeiro-Vaz I, Marques J, Demoly P, et al. Drug-induced anaphylaxis: a decade review of reporting to the Portuguese Pharmacovigilance Authority. European Journal of Clinical Pharmacology, 2012;69(3), 673–681.
• 15-Dhopeshwarkar N, Sheikh A, Doan R, et al. Drug-Induced Anaphylaxis Documented in Electronic Health Records. J Allergy Clin Immunol Pract, 2019; 7(1): P103-111.
• 16-Regateiro FS, Marques ML, Gomes ER. Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors. Int Arch Allergy Immunol 2020;181:481–487.
• 17- Guvenir H , Misirlioglu E.D. , Capanoglu M. et al. The Frequency of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity in Children with Asthma Int Arch Allergy Immunol.2018;176(1):26-32.
• 18- Alves C, et al. Non-steroidal anti-inflammatory drug hypersensitivity in children. Allergol Immunopathol (Madr). 2017 Jan-Feb;45(1):40-47
• 19- Kowalski ML, Makowska JS, Blanca M, et al.Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA and GA2LEN/HANNA .Allergy. 2011 Jul;66(7):818-29.
• 20- Kidon M.I., Kang L.W, Chin C.W. et al.Nonsteroidal Anti-Inflammatory Drug Hypersensitivity in Preschool Children Allergy Asthma Clin Immunol. 2007 Dec 15;3(4):114-22.
• 21- Sánchez-Borges M, et al. Atopy is a risk factor for non-steroidal anti-inflammatory drug sensitivity. Ann Allergy Asthma Immunol. 2000
• 22- Ortega N, Doña I, Moreno E. et al. Practical guidelines for diagnosing hypersensitivity reactions to nonsteroidal anti-inflammatory drugs.J Investig Allergol Clin Immunol. 2014
• 23- Farkas H , Martinez-Saguer I , Bork K.et al. International consensus on the diagnosis and management of pediatric patients with hereditary angioedema with C1 inhibitor deficiency. Allergy,2017.
• 24- Kidon MI, Kang LW, Chin CW.et al. Early presentation with angioedema and urticaria in cross-reactive hypersensitivity to nonsteroidal antiinflammatory drugs among young, Asian, atopic children. Pediatrics. 2005 Nov;116(5):e675-80.
• 25 - Gülfem E. Çelik A. Berna Dursun İlaç Aşırı Duyarlılık Reaksiyonlarına Yaklaşım: Ulusal Rehber Güncellemesi 2019
• 26- Saretta F, Mori F, Cardinale F.et al Pediatric drug hypersensitivity: which diagnostic tests? Acta Biomed. 2019 Jan 30;90(3-S):94-107.
• 27- Blanca-López N, et al. Hypersensitivity Reactions to Nonsteroidal Anti-inflammatory Drugs in Children and Adolescents: Selective Reactions. J Investig Allergol Clin Immunol. 2015
• 28-Caffarelli C, Franceschini F, Caimmi D. Et al.SIAIP position paper: provocation challenge to antibiotics and non-steroidal anti-inflammatory drugs in children. J Pediatr. 2018 Dec 7;44(1):147 29-Tugcu GD, Cavkaytar O, Sekerel BE, et al. Actual drug allergy during childhood: Five years' experience at a tertiary referral centre.Allergol Immunopathol (Madr) 2015;43(6):571-8 30-Yilmaz O, Ertoy Karagol IH, Bakirtas A,et al. Challenge-proven nonsteroidal anti-inflammatory drug hypersensitivity in children. Allergy. 2013;68:1555-61.