The Rational Approach to a Patient with Hypersensitivity to Non-steroid Anti-inflammatory Drugs

Yıl 2019, Cilt: 11 Sayı: 2, 54 - 57, 07.03.2019

Uzm. Dr. Sevgi Sipahi Çimen

Öz

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonlyused drugs in childhood and are the second most common drugs after antibiotics indrug related hypersensitivity reactions. NSAIDs induce hypersensitivity reactionsin sensitive individuals varying in timing, organ involvement and severity. Hypersensitivity reactions to NSAIDs are classified as allergic (caused by immunological mechanism) and non-allergic (non-immunological) reactions according to the underl-ying mechanism. The diagnosis of NSAIDs hypersensitivity is usually based on clinical history, but patients who have been evaluated with history alone may be misdiagnosed as drug allergy. It is recommended to evaluate the patient with detailedhistory, physical examination and standardized diagnostic tests for definitive diagnosis.

Non-Steroid Antiinflamatuar İlaç Aşırı Duyarlılığı Olan Hastaya Akılcı Yaklaşım

Öz

Öz

Non-steroidal antiinflamatuar ilaçlar (NSAİİ), çocukluk çağında en sık kullanılan ilaçlar arasındadır ve ilaç ilişkili aşırı duyarlılık reaksiyonları içinde antibiyotiklerden sonra ikinci sırada yer almaktadır. Duyarlı bireylerde zamanlaması, organ tutulumu ve şiddeti değişen aşırı duyarlılık reaksiyonlarına neden olmaktadır. Aşırı duyarlılık reaksiyonları altta yatan mekanizmaya göre alerjik (immünolojik mekanizma ile oluşan) ve alerjik olmayan (non-immünolojik) reaksiyonlar olarak ikiye ayrılır. Tanı genellikle öyküye dayanmaktadır, ancak tek başına öykü ile değerlendirilen hastalar yanlışlıkla ilaç alerjisi tanısı alabilmektedir. Kesin tanı için hastanın ayrıntılı öykü, fizik muayene ve standardize edilmiş tanısal testler ile birlikte değerlendirilmesi önerilmektedir.

Anahtar Kelimeler

alerji, çocuk, non-steroid antiinflamatuar ilaç

Kaynakça

• Kaynaklar 1. Roberts LJ, Morrow JD. Analgesic-antipyretic and antiinflammatory agentsand drugs employed in the treatment of gout. In: Hardman JG, Limbird LL,Goodman Gilman A, editors. The pharmacological basis of therapeutics.10th edition. New York: McGraw-Hill; 2001. p. 687–731. 2. Ayuso P, Blanca-Lopez N, Dona I, Torres Mf, Gueant-Rodrlguez RM, CantoG, et al. Advanced phenotyping in hypersensitivity drug reactions to NSAIDs.Clin Exp Allergy 2013;43:1097-109. 3.Hedman J, Kaprio J, Poussa T. Prevalence of asthma, aspirin intolerance,nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol 1999;28:717–722. 4.Dona I, Blanca-Lopez N, Torres MJ, Garcia-Campos J, Garcia-Nunez I, Go-mez F et al. Drug hypersensitivity reactions: response patterns, drug invol-ved, and temporal variations in a large series of patients. J Investig AllergolClin Immunol 2012;22:363–371. 5.Vane JR. Inhibition of prostaglandin synthesis as a mechanism of actionfor aspirin-like drugs. Nat New Biol 1971;43:232–5. 6.Kowalski ML, Asero R, Bavbek S, Blanca M, Blanca-Lopez N, Boche-nek G, et al. Classification and practical approach to the diagnosis andmanagement of hypersensitivity to nonsteroidal antiinflammatory drugs.Allergy. 2013 Oct;68(10):1219-32. 7.Stevenson DD1, Szczeklik A. Clinical and pathologic perspectives on aspirinsensitivity and asthma. J Allergy Clin Immunol. 2006 Oct;118(4):773-86. 8.Kowalski ML, Demoly P, Pichler WJ, Sanchez-Borges M. Hypersensi-tivity to drugs and biological agents. In: Pawankar R, Canonica W, Hol-gate ST, Lockey RF, editors. WAO White Book on Allergy, Milwaukee:WAO, 2012: 57–61. 9.Rawlins MD, Thompson JW. Pathogenesis of adverse drug reactions. In: Da-vies DM editor. Textbook of Adverse Drug Reactions. Oxford: Oxford Univer-sity Press, 1977: 10. 10.Kowalski ML, Makowska JS. Seven steps to the diagnosis of NSAIDs hyper-sensitivity: how to apply a new classification in realpractice?. Allergy Asth-ma Immunol Res. 2015 Jul;7(4):312-20. 11.Kidon M, Blanca-Lopez N, Gomes E, Terreehorst I, Tanno L, Ponvert C, et al.EAACI/ENDA Position Paper: Diagnosis and management of hypersensitivityreactions to non-steroidal anti-inflammatory drugs (NSAIDs) in children andadolescents. Pediatr Allergy Immunol. 2018 Aug; 29(5): 469-480. 12. Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bous-quet J, et al. Hypersensitivity to nonsteroidal antiinflammatory drugs (NSA-IDs) - classification, diagnosis and management: review of theEAACI/ENDA and GA2LEN/HANNA. Allergy. 2011 Jul;66(7):818-29. 13. Szczeklik A, Nizankowska E, Duplaga M. Natural history of aspirin- in-duced asthma. AIANE Investigators. European Network on Aspirin-In-duced Asthma. Eur Respir J 2000;16:432-6. 14. Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, BiloMB, et al. Skin test concentrations for systemically administered drugs-anENDA/EAACI Drug Allergy Interest Group position paper. Allergy 2013;68:702e12. 15. Nizankowska-Mogilnicka E, Bochenek G, Mastalerz L, Swierczyńska M,Picado C, Scadding G, Kowalski ML, et al. EAACI / GA2LEN guideli-ne: aspirin provocation tests for diagnosis of aspirin hypersensitivity. Al-lergy. 2007 Oct;62(10):1111-8.