title: Hypersensitivity Reactions to Nonsteroidal Anti-inflammatory Drugs in Children and Adolescents: Selective Reactions.
abstract: Nonsteroidal anti-inflammatory drugs (NSAIDs) are used throughout the world to treat pain and inflammation; however, they can trigger several types of drug hypersensitivity reactions (DHRs) in all age groups. Although most such reactions occur through activation of the leukotriene pathway without specific immunological recognition (cross-intolerance), a significant number of DHRs to NSAIDs are due to immunological mechanisms (selective reactions [SRs]). SRs are thought to be induced by specific IgE antibodies or by T cells. In this manuscript, we focus on SRs, which are of great concern in children and adolescents and comprise a heterogeneous set of clinical pictures ranging from mild entities such as urticaria/angioedema to potentially life-threatening conditions such as Stevens-Johnson syndrome/toxic epidermal necrolysis. Paracetamol and ibuprofen are the most frequent elicitors of IgE-mediated SRs, although pyrazolones have also been implicated. T cell-mediated reactions are infrequent in children but have been associated with ibuprofen, naproxen, and dipyrone. In this review, we analyze the available literature on SRs in children and adolescents, with emphasis on epidemiological data, mechanisms, and drugs involved, as well as on diagnostic procedures.
authors.forename: N
authors.initials: N
authors.lastname: Blanca-López
authors.forename: J A
authors.initials: JA
authors.lastname: Cornejo-García
authors.forename: D
authors.initials: D
authors.lastname: Pérez-Alzate
authors.forename: N
authors.initials: N
authors.lastname: Pérez-Sánchez
authors.forename: M C
authors.initials: MC
authors.lastname: Plaza-Serón
authors.forename: I
authors.initials: I
authors.lastname: Doña
authors.forename: M J
authors.initials: MJ
authors.lastname: Torres
authors.forename: G
authors.initials: G
authors.lastname: Canto
authors.forename: M
authors.initials: M
authors.lastname: Kidon
authors.forename: J R
authors.initials: JR
authors.lastname: Perkins
authors.forename: M
authors.initials: M
authors.lastname: Blanca
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002648:Child; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal