title: Value of the clinical history in the diagnosis of urticaria/angioedema induced by NSAIDs with cross-intolerance.
abstract: BACKGROUND
  Multiple Non-steroidal anti-inflammatory drugs (NSAID)-induced urticaria/angioedema is the most common manifestation of hypersensitivity reactions to NSAIDs. Diagnostic evaluation is based on the clinical history and a drug provocation test.
  
  
  OBJECTIVE
  To evaluate the role of the clinical history in the diagnosis of multiple NSAID-induced urticaria/angioedema.
  
  
  METHODS
  We studied a group of patients with an unequivocal history of urticaria and/or angioedema after NSAID intake. Subjects had to have had at least two episodes of cutaneous symptoms with two different COX-1 inhibitors. The diagnosis was confirmed in all cases by a drug provocation test with acetyl salicylic acid (ASA). Multivariate analysis was done by analysing different variables, including number of drugs involved, episodes and time elapsed between drug intake and symptom onset.
  
  
  RESULTS
  Of the total group of 75 cases with multiple NSAID-induced urticaria/angioedema diagnosed according to the clinical history, 76% developed a positive drug provocation test with ASA. The risk for having hypersensitivity was 17 times higher in patients who developed symptoms within the first 60 min after drug intake, 13 times higher in those who experienced reactions with more than two non-chemically related NSAIDs, and 10 times higher in women.
  
  
  CONCLUSIONS
  Drug provocation testing with ASA confirms the diagnosis of multiple NSAID-induced urticaria/angioedema in up to 92% of cases with an unequivocal clinical history, when reactions occur within 1 h and more than two different NSAIDs are involved.
authors.affiliation: Allergy Service, Infanta Leonor Hospital, Madrid, Spain. natalia.blanca@gmail.com
authors.forename: N
authors.initials: N
authors.lastname: Blanca-Lopez
authors.forename: M
authors.initials: M
authors.lastname: J Torres
authors.forename: I
authors.initials: I
authors.lastname: Doña
authors.forename: P
authors.initials: P
authors.lastname: Campo
authors.forename: C
authors.initials: C
authors.lastname: Rondón
authors.forename: M E
authors.initials: ME
authors.lastname: Seoane Reula
authors.forename: M
authors.initials: M
authors.lastname: Salas
authors.forename: G
authors.initials: G
authors.lastname: Canto
authors.forename: M
authors.initials: M
authors.lastname: Blanca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000139:chemically induced / Q000175:diagnosis*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000276:immunology; D001241:Aspirin; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014581:Urticaria / Q000139:chemically induced / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin