title: Provocation tests with the offending nonsteroidal anti-inflammatory drugs in patients with urticaria/angioedema reactions.
abstract: The provocation test (PT) with the suspected drug represents the gold standard in the diagnosis of non-IgE hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). Nevertheless, there is no consensus regarding the clinical management of suspected NSAID-sensitive  patients. This study assessed if a PT with the suspected drug is a reliable and safe proceeding to confirm NSAID hypersensitivity in patients with a clinical history of urticaria/angioedema (Urt/AE). It also analyzed different patient characteristics (such as gender, age, atopy, dermographism,  time interval between the last drug reaction, and number of previous NSAID reactions) in relation to PT positivity. One hundred fifty-nine patients with Urt/AE apparently related to assumption of one or more NSAIDs underwent PT with the suspected drugs. Moreover, to distinguish single/multiple  NSAID reactivity in patients who did not tolerate the offending NSAID, another strong cyclooxygenase-1 inhibitor PT was performed. PT was negative in 142/159 patients (89.31%), ruling out a diagnosis of NSAIDs hypersensitivity; 17/159 patients (10.69%) experienced a reaction of Urt/AE during  the PT: 8 patients were diagnosed as single reactors to NSAIDs and 4 as multiple reactors to NSAIDs. Those with a history of multiple NSAID reactions and male patients were both more likely to have a positive PT. Our results suggest that in all patients with history of NSAID cutaneous reactions,  the NSAID hypersensitivity should be confirmed by an oral PT and that the diagnostic proceeding can safely start with the offending NSAID.
authors.affiliation: Allergology and Immunology Unit, Novara Hospital-Experimental Program Piemonte Allergy Network, Novara, Italy. giuliana.zisa@libero.it
authors.forename: Giuliana
authors.initials: G
authors.lastname: Zisa
authors.forename: Francesca
authors.initials: F
authors.lastname: Riccobono
authors.forename: Luisa
authors.initials: L
authors.lastname: Bommarito
authors.forename: Cristian
authors.initials: C
authors.lastname: D'Antonio
authors.forename: Ambra Marianna
authors.initials: AM
authors.lastname: Calamari
authors.forename: Mariangela
authors.initials: M
authors.lastname: Poppa
authors.forename: Maria Adele
authors.initials: MA
authors.lastname: Moschella
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Pietrantonj
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galimberti
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000799:Angioedema / Q000139:chemically induced* / Q000175:diagnosis; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D014581:Urticaria / Q000139:chemically induced* / Q000175:diagnosis; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal