title: Anaphylaxis to diclofenac: nine cases reported to the Allergy Vigilance Network in France.
abstract: Nine cases of diclofenac hypersensitivity recorded by the Allergy Vigilance Network in France from 2002 to 2012 were studied. Data from history, symptoms, skin tests, basophil activation tests, and oral challenge (OC) were recorded. Grade 3 severe anaphylactic reactions occurred in seven cases of nine. IgE-dependent anaphylaxis was confirmed in six cases: positive intradermal tests (n = 4), a syndromic reaction during skin tests (n = 1), and one case with grade 1 reaction and negative skin tests had an anaphylactic shock to the OC. A nonimmune reaction was suspected in one case. An IgE-dependent mechanism may be the predominant cause of adverse reactions to diclofenac. Allergy skin tests must be carried out sequentially at the recommended concentrations. BATs may be helpful because they can support the diagnosis of anaphylaxis. Given the risks of a direct challenge to diclofenac, OC to aspirin should be performed first to exclude a nonimmunologic hypersensitivity to NSAIDs. Tests for specific IgEs to most frequently used NSAIDs such as diclofenac and ibuprofen are urgently needed.
authors.affiliation: Allergy Department, Emile Durkheim Hospital, Epinal, France; Allergy Vigilance Network, Vandoeuvre les Nancy, France.
authors.forename: J
authors.initials: J
authors.lastname: Picaud
authors.forename: E
authors.initials: E
authors.lastname: Beaudouin
authors.forename: J M
authors.initials: JM
authors.lastname: Renaudin
authors.forename: F
authors.initials: F
authors.lastname: Pirson
authors.forename: C
authors.initials: C
authors.lastname: Metz-Favre
authors.forename: M
authors.initials: M
authors.lastname: Dron-Gonzalvez
authors.forename: D A
authors.initials: DA
authors.lastname: Moneret-Vautrin
mesh_terms: D000368:Aged; D000707:Anaphylaxis / Q000276:immunology*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000276:immunology; D004008:Diclofenac / Q000009:adverse effects* / Q000276:immunology; D004342:Drug Hypersensitivity / Q000276:immunology*; D005260:Female; D005602:France; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D008875:Middle Aged
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D007073:Immunoglobulin E
keywords: anaphylaxis; basophil; diclofenac; drug allergy; skin test