title: Prevention of nonsteroidal inflammatory drug-induced urticaria and/or angioedema.
abstract: BACKGROUND
  Urticaria and/or angioedema (U/AE) are the most frequent and less severe forms of nonallergic hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). Management of NSAID-induced U/AE includes (1) the avoidance of the culprit drug and of cyclooxygenase (COX) 1 inhibitors, (2) the use of weak COX-2 inhibitors, and/or (3) desensitization to aspirin. Because these possibilities may have drawbacks, we tested the possibility of preventing NSAID-induced U/AE by the administration of antihistamines and/or a combination of antihistamines and leukotriene antagonists.
  
  
  OBJECTIVE
  To test the preventive effect of antihistamines and/or leukotriene antagonists on the development of U/AE in patients with a history of NSAID hypersensitivity confirmed by a positive challenge result.
  
  
  METHODS
  A single, placebo-controlled, oral challenge using the culprit NSAID was applied to 65 patients with a history of NSAID-induced U/AE. In the case of recurrence of the symptoms, another oral challenge was performed under premedication with antihistamines alone or combined antihistamines and leukotriene antagonists.
  
  
  RESULTS
  A total of 59 of 65 patients (90%) tolerated a normal dose of NSAID, confirming previous data on the poor reproducibility of nonallergic hypersensitivity reactions to NSAIDs on challenge. Of the 6 patients who experienced recurrence of the U/AE on NSAID challenge, antihistamines and combined antihistamines and leukotriene antagonists prevented the hypersensitivity reactions in 2 and 3 of them, respectively. Only 1 patient still developed a moderate NSAID-induced urticaria despite the double premedication.
  
  
  CONCLUSIONS
  Treatment with NSAIDs at normal doses is possible and well tolerated in patients who have experienced NSAID-induced U/AE, which could be prevented by the concomitant use of antihistamines and leukotriene antagonists.
authors.affiliation: Allergy and Clinical Immunology Department, CHU Lyon-Sud, Pierre Bénite, France. audrey.nosbaum@chu-lyon.fr
authors.forename: Audrey
authors.initials: A
authors.lastname: Nosbaum
authors.forename: Marion
authors.initials: M
authors.lastname: Braire-Bourrel
authors.forename: Rolande
authors.initials: R
authors.lastname: Dubost
authors.forename: Amélie
authors.initials: A
authors.lastname: Faudel
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Parat
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Nicolas
authors.forename: Frédéric
authors.initials: F
authors.lastname: Bérard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000799:Angioedema / Q000139:chemically induced / Q000150:complications / Q000517:prevention & control*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000209:etiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D006633:Histamine Antagonists / Q000008:administration & dosage*; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014581:Urticaria / Q000139:chemically induced / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006633:Histamine Antagonists; D020024:Leukotriene Antagonists