Ibuprofen allergy in children: impact of the I3A tool
Published online December 3, 2024
Ibuprofen is a major cause of drug allergy in children. The gold standard for diagnosis is a potentially high-risk procedure, a drug challenge to ibuprofen itself. Currently, no risk-stratification tool exists to increase the safety of these challenges. This study aims to bridge this knowledge gap by proposing and validating a clinical risk-stratification tool to predict the risk of positive challenge in children with suspected ibuprofen allergy.
In this study by Stehlin, Ben Shoshan et al, published in The Journal of Allergy and Clinical Immunology: In Practice, children with suspected ibuprofen allergy were prospectively recruited and received an ibuprofen challenge between January 2017 and March 2024. Based on the characteristics of the patients, of the index reactions, and of the challenge outcome, a predictive score for a positive ibuprofen challenge was calculated using stepwise bidirectional multivariable logistic regression.
Eighty-two children were included, among them, eighteen (22.0%) had a positive challenge, with eleven (61.1% of positive challenges) having an anaphylactic challenge reaction. The predictive score created is named I3A (acronym for Ibuprofen, 3As: Angioedema, Anaphylaxis, Age, Cut-off of 3) and encompasses the following items: Angioedema (2 points), Anaphylaxis (1 point), and Age at reaction ≥ 10 years old (1 point). The predictive score performs well, the optimal cut-off of <3 highlights a low-risk population with a tolerance of ibuprofen challenge of 94.7% and anaphylaxis upon challenge in 3.5%. The risk of reacting to challenge and to have anaphylaxis was more than 10 times higher in the group I3A score of 3-4 as compared to I3A score 0-2. In conclusion, the I3A score is an efficient risk stratification tool to identify children at low risk of reacting to ibuprofen challenge. Further validation is required in external cohorts.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
Full Article