Nonsteroidal anti-inflammatory drug hypersensitivity: fable or reality?
In the medical community lectures and publications about nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity have led to an increasing awareness and diagnosis of this condition. Frequently, the diagnosis NSAID hypersensitivity is based only on history, which is a vague and unreliable indicator. A two-stage diagnostic procedure with skin tests (to exclude IgE-mediated allergy) followed by single-blinded, placebo-controlled oral challenges was carried out on patients attending our clinic from 1997 to 2003 with the diagnosis of a NSAID hypersensitivity. Out of 260 patients tested, 61.5% described their NSAID hypersensitivity as cutaneous (urticaria, angioedema), 24.2% had respiratory symptoms (asthma, rhinitis), 3.5% had anaphylactoid reactions, and 10.8% described uncertain signs. In fact 55.0% of all patients previously labelled as NSAID sensitive tolerated NSAID when assessed by oral challenge, whereas 13.8% were truly NSAID sensitive. In 31.2% of patients the challenge test with the suspicious drug was either not done or rejected by the patient; but all showed a proven tolerance of alternative NSAID. Our study demonstrates that oral challenge tests are safe, practical and useful in ruling out NSAID hypersensitivity in approximately 50% of the patients who have previously been labelled as such.
Schubert
Barbara
B
Department of Dermatology, University of Würzburg, Josef Schneider Strasse 2, D-97080 Würzburg, Germany.
Grosse Perdekamp
Maria T
MT
Pfeuffer
Petra
P
Raith
Petra
P
Bröcker
Eva-B
EB
Trautmann
Axel
A
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D002648:Child; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010328:Patch Tests / Q000379:methods*; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D016037:Single-Blind Method; D012867:Skin / Q000187:drug effects
D000894:Anti-Inflammatory Agents, Non-Steroidal