Non-steroidal anti-inflammatory drug hypersensitivity in children

C. Alves; A. M. Romeira; C. Abreu; P. Carreiro Martins; E. Gomes; P. Leiria-Pinto

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Non-steroidal anti-inflammatory drug hypersensitivity in children

C. Alves ^[1] ; A.M. Romeira ^[1] ; C. Abreu ^[2] ; P. Carreiro-Martins ^[1] ; E. Gomes ^[2] ; P. Leiria-Pinto ^[1]
1. [1] Centro Hospitalar de Lisboa Central
  
  Centro Hospitalar de Lisboa Central
  
  Socorro, Portugal
2. [2] Centro Hospitalar do Porto
  
  Centro Hospitalar do Porto
  
  Santo Ildefonso, Portugal
Localización: Allergologia et immunopathologia: International journal for clinical and investigate allergology and clinical immunology, ISSN-e 1578-1267, ISSN 0301-0546, Vol. 45, Nº. 1, 2017, págs. 40-47
Idioma: inglés
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Resumen
- Introduction There are rather few publications about hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAID) in the paediatric age. In this study, we aimed to assess the frequency of confirmed NSAID hypersensitivity in children with a previous reported reaction to NSAID in order to investigate the role of the drug provocation test (DPT) in the diagnostic workup and to explore the factors associated with confirmed NSAID hypersensitivity.
  
  Methods We conducted a retrospective analysis of the clinical files from every patient under 18 years old who attended two Portuguese paediatric allergy outpatient clinics, from January 2009 to August 2014, due to a suspected NSAID hypersensitivity.
  
  Results We included 119 patients, with a median age of nine years (P25–P75: 5–14). Ibuprofen was the commonest implicated NSAID in the patients’ reports (n = 94–79%). After DPT, NSAID hypersensitivity was confirmed in nine (7.6%) patients, excluded in 93 (78.2%) and was inconclusive in 17 (14.3%). In the majority (n = 95–79.8%), the reaction occurred in the first 24 h after intake. Eighty-four patients (70.6%) reported only cutaneous manifestations and 18 (15.1%) had systemic symptoms. Anaphylaxis represented a relative risk to NSAID hypersensitivity confirmation. No association was found for atopy and the number of previous reactions.
  
  Conclusion In our study, NSAID hypersensitivity was confirmed in a small proportion of the patients with a previous reported reaction. Ibuprofen was the most implicated drug with urticaria/angio-oedema as the commonest manifestation. Anaphylaxis was associated with confirmed drug hypersensitivity. The drug provocation test was essential to establish the diagnosis.