title: Challenge-proven aspirin hypersensitivity in children with chronic spontaneous urticaria.
abstract: BACKGROUND
  Nonsteroidal anti-inflammatory drug (NSAID) exacerbated cutaneous disease is defined as the exacerbation of wheals and/or angioedema in patients with a history of chronic spontaneous urticaria (CSU). The objective of this study was to define 'aspirin-hypersensitive' children and adolescents in a clearly defined group of patients with CSU and to describe their clinical features.
  
  
  METHODS
  Eighty-one children with a history of CSU were enrolled over a 3-year period. The daily or almost daily (>4 days a week) presence of urticaria was defined as 'chronic persistent urticaria' (CPU), while the presence of urticaria for 2-4 days a week was defined as 'chronic recurrent urticaria' (CRU). Single-blind, placebo-controlled provocation tests (SBPCPTs) with aspirin were performed for children with CSU.
  
  
  RESULTS
  Patients with CRU had a longer duration of cutaneous symptoms [1.6 (0.5-4) vs 0.6 (0.3-1.5) years], and stress was less frequently experienced as an eliciting factor in patients with CRU compared with the patients with CPU (P < 0.016, P = 0.024, respectively). SBPCPTs with aspirin revealed that 14 of 58 patients (24%) with CPU and one of 10 patients with CRU (10%) were aspirin hypersensitive. Aspirin hypersensitivity rate was 26.5% in patients <12 years of age. All of the 15 aspirin-hypersensitive patients (aged between 6.6 and 17.4 years), except for three, experienced an unequivocal angioedema of the lips as a positive reaction in SBPCPT.
  
  
  CONCLUSIONS
  Nearly a quarter of children and adolescents with CSU were hypersensitive to aspirin. For children with chronic urticaria, determination of NSAID hypersensitivity in a well-controlled clinical setting will help to avoid severe drug hypersensitivity reactions.
authors.affiliation: Department of Pediatric Allergy, School of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Cavkaytar
authors.forename: Ebru
authors.initials: E
authors.lastname: Arik Yilmaz
authors.forename: Betul
authors.initials: B
authors.lastname: Buyuktiryaki
authors.forename: Bulent E
authors.initials: BE
authors.lastname: Sekerel
authors.forename: Cansin
authors.initials: C
authors.lastname: Sackesen
authors.forename: Ozge U
authors.initials: OU
authors.lastname: Soyer
mesh_terms: D000293:Adolescent; D000799:Angioedema / Q000209:etiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002908:Chronic Disease; D015897:Comorbidity; D018450:Disease Progression; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D011379:Prognosis; D014581:Urticaria / Q000139:chemically induced* / Q000175:diagnosis*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
keywords: aspirin; chronic urticaria; drug allergy; nonsteroidal anti-inflammatory drug