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Hypersensitivity reactions to Non-Steroidal Anti-inflammatory Drugs in European children

November 27, 2019

Diagnosis of Non-Steroidal Anti-inflammatory Drugs (NSAIDs) and paracetamol hypersensitivity (HS) is complex due to lack of good diagnostic testing modalities besides drug provocation test (DPT). Moreover, the exact prevalence remains unknown because most of the studies are based on the clinical history. Also, few studies have focused on children and adolescents separately, taking into account the different age-related drug metabolism and age-related role of co-factors.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice,  Mori F et al. retrospectively investigated a large number of pediatric/adolescent patients with suspected NSAID/paracetamol HS from six different centers in Europe. The article focused on similarities and differences in the diagnostic workup, frequency of phenotypes and clinical manifestations observed in each country, NSAIDs most commonly reported as involved in drug HS reactions, and the actual proportion of NSAID HS among children and adolescents confirmed by DPT.

The authors showed that among 693 children with a history of NSAIDs reactions, 526 DPTs were performed with the culprit NSAID and confirmed the diagnosis of NSAIDs HS in only19.6%. In younger children (≤ 2 years), the diagnosis was confirmed in only 7% of patients evaluated, highlighting the possible role of cofactors. Ibuprofen was the most frequently involved drug, and angioedema with or without urticaria was the most common manifestation. The major differences in the allergy workup among the six centers concerned the duration of the DPT and the practical use of skin tests for diagnosing NSAIDs HS. In addition, the use of acetyl salicylic acid (ASA) to differentiate single reactors (SR) or cross-intolerance (CI) patients is not commonly used except in Spain.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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