A new method of oral drug provocation testing for determining safe alternatives for patients with non-steroidal anti-inflammatory drug intolerance: the triple test.
BACKGROUND
Although some of the non-steroidal anti-inflammatory drugs (NSAIDs) are reported to be safe for NSAID-intolerant patients, they should not be suggested before confirming the safety by single-blind oral drug provocation tests. Various test protocols are used in different allergy centers. The aim of this survey was to find out if testing three drugs a day could be a safe, time-saving and cost-effective method.


METHODS
We have enrolled 84 patients into this survey between September 1, 2002, and July 31, 2004.


RESULTS
Their mean age was 37.3+/-11.0 years; 63 (75%) patients were female. By reliable history, the NSAID most commonly causing intolerance was aspirin (46.4%), and the most common reaction to analgesic intolerance was angioedema (60.7%). Eighty-seven tests were performed with meloxicam, rofecoxib, celecoxib, benzydamine, azapropazone, codeine and paracetamol in various triple combinations. Seventeen of the triple tests were positive, and one of them was suspiciously positive. After repeating these 18 tests with the same analgesics in the same order on 54 separate days, we have determined the responsible analgesics for 14 of the triple tests. There were no reactions when four of the triple tests were repeated on separate days (two of the triple tests demonstrated urticaria and the other two angioedema). Five patients had nausea and vomiting, and 2 had abdominal pain and other dyspeptic complaints during the tests. If we had performed the tests by the classical method, 264 days would have elapsed instead of 148 days (including the extra tests that we have performed after positive triple tests and gastrointestinal symptoms).


CONCLUSIONS
The triple oral drug provocation testing seems to be a safe, time-/manpower-saving and cost-effective method for determining safe alternatives for NSAID-intolerant patients.
Kalyoncu
A F
AF
Department of Chest Diseases, Adult Allergy Unit, Hacettepe University School of Medicine, Ankara, Turkey.
Karakaya
G
G
Bozkurt
B
B
Artvinli
M
M
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000592:standards; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
D000894:Anti-Inflammatory Agents, Non-Steroidal