Thank you for your recent inquiry.
Unfortunately, I could find no published protocol for challenge dosing to ibuprofen. There are two excellent review articles that have a section on aspirin and nonsteroidal antiinflammatory drug reactions and outline a protocol for desensitization to aspirin. But, there is no mention in these articles of any specific regimen for any nonsteroidal antiinflammatory drug and, as noted, I could not find any mention of this either in the recently published Parameters on Drug Reactions, the Annals of Allergy, Asthma, and Immunology, the Journal of Allergy, Asthma, and Immunology, or PubMed.
Therefore any protocol that you use will have to be one that is specifically designed for your patient.
The references that I note below can be used to give you a rough idea of a starting dose based upon the dose employed for aspirin compared to a therapeutic dose of aspirin.
Otherwise you could arbitrarily set up a protocol similar to one which we have used previously. We employ liquid ibuprofen. Liquid ibuprofen can be obtained in a dose of 100 mg per 5 cc. One cc therefore contains 20 mg. We usually start the desensitization protocol with 0.1cc (2 mg), and double the dose every 30 minutes. Using this protocol, in approximately three hours, a top dose dose of about 128 mg and a cuulative dose of about 270mg is reached.
You could of course spread the dosing out over time or approach it in even a more cautious manner, depending upon your assessment of the severity of the patient's reaction.
Also, I think you need to take into consideration the variety of forms of anaphylactic-like reactions to ibuprofen (e.g., those involving Cox inhibition and those not) as discussed in the most recent Practice Parameters on Drug Reactions which is available to you online (3).
Thank you again for your inquiry and we hope this response is helpful to you. References:
1. Castells M. Rapid desensitization for hypersensitivity reaction to medications. Immunology and Allergy Clinics of North America, 2009 (August); 29(3):585-606.2. Castells M. Desensitization for a drug allergy. In: Current Opinion in Allergy and Clinical Immunology, 2006; 6:476-481.
3. Solensky R, Kahn DA, et al. Drug Allergy: An Updated Practice Parameter. Annals of Allergy, Asthma, and Immunology, 2010; 105:273.
Sincerely, Phil Lieberman, M.D.