PURPOSE OF THE STUDY.
The goal of this study was to determine the frequency of true nonsteroidal antiinflammatory drug hypersensitivity (NSAID-H) and whether there were any factors in the history that could predict NSAID-H in children.
The study population included 58 children, aged 4 months through 17.8 years, with suspected NSAID-H based on a history of acute reactions, including urticaria/angioedema, bronchospasm, laryngeal edema, rhinitis, and systemic reactions involving hypotension, laryngeal edema, bronchospasm, and/or shock.
All subjects completed a questionnaire detailing the implicated NSAID, their reaction history, and any individual risk factors. Subjects were stratified into 2 separate groups: those who reacted to a single NSAID and those who reacted to multiple NSAIDs. Based on a diagnostic algorithm, those with a positive result on skin prick test (SPT) to a single NSAID (n = 1) were labeled as NSAID-H, and those with negative or no available SPT underwent an oral provocation test (OPT). Those with a confirmed history of anaphylaxis did not undergo OPT. Subjects with a history of reaction to ≥2 NSAIDs underwent OPT. Subjects received 4 to 5 escalating doses of the culprit NSAID at 60-minute intervals until they reached the maximum single dose. Patients were observed for 2 hours after the OPT to monitor for delayed reaction. All challenges were continued for 2 days at home, and subjects were contacted via telephone for follow-up. OPTs were performed in all children with confirmed NSAID-H in an attempt to find a safe alternative.
Sixty-five percent (n = 38) reported a reaction to a single NSAID. Thirty-five of these subjects underwent an OPT, and 5 had proven NSAID-H. Of the 20 patients who reported reactions to multiple NSAIDs, 8 had proven NSAID-H with OPT. Twelve patients were challenged to find a safe alternative, of whom 60% tolerated acetaminophen and 89% tolerated nimesulide. There was no association between gender, atopic status, presence of atopic disease, history of anaphylaxis, history of multiple reactions with the same NSAID, and safe use of a similar group of NSAD and OPT results. Family history of NSAID-H and having a reaction with multiple NSAIDs were associated with a positive result on OPT.
A history of reaction to both single and multiple NSAIDs was usually not indicative of true drug hypersensitivity. Therefore, diagnostic tests should be considered in all children with suspected NSAID-H.
Although suspected allergic reactions to NSAIDs are very common, true allergy is uncommon in children compared with adults. This impression was confirmed in this study, with true allergy confirmed in only ∼25% of those reporting a history of reaction. This study also confirms the value in performing provocation tests, and the lack of value in skin testing, in children presenting with a history of a suspected NSAID allergy.
- Copyright © 2014 by the American Academy of Pediatrics