title: Predictive value of a negative oral provocation test in patients with hypersensitivity to analgesics.
abstract: BACKGROUND
  Nonsteroidal anti-inflammatory drugs (NSAIDs) take first or second place as the cause of drug-induced hypersensitivity reactions. The oral provocation test (OPT) is a gold standard for the diagnosis of NSAID hypersensitivity. We investigated which analgesics patients took after a negative OPT and determined the proportion of patients that experienced a hypersensitivity reaction despite a negative OPT.
  
  
  METHODS
  We selected 115 patients (67.8% female, age 54.9 ± 16.7 years) with a negative aspirin OPT and a convincing history of immediate hypersensitivity to aspirin or NSAIDs. In a telephone survey, we identified the analgesics taken after the OPT and possible adverse events.
  
  
  RESULTS
  The mean follow-up time was 5.1 ± 2.0 years. All subjects needed at least one analgesic drug. Despite the negative outcome of the aspirin OPT, only 33.9% of subjects took aspirin and 0.9% had a hypersensitivity reaction. The negative predictive value (NPV) of the aspirin OPT was 97.4%. Overall, 16 (13.9%) subjects experienced a hypersensitivity reaction, 12 of which occurred after taking a drug not tested with the OPT. The NPV of the OPT for all NSAIDs was 96.4%.
  
  
  CONCLUSIONS
  Our results support the available data that most subjects do not re-take the tested drug regardless of the high NPV of the OPT.
authors.affiliation: Medical Faculty, University of Ljubljana, Ljubljana, Slovenia; Maja Jakič and Miha Jager contributed equally as the first authors.
authors.forename: Maja
authors.initials: M
authors.lastname: Jakič
authors.affiliation: Medical Faculty, University of Ljubljana, Ljubljana, Slovenia; Maja Jakič and Miha Jager contributed equally as the first authors.
authors.forename: Miha
authors.initials: M
authors.lastname: Jager
authors.affiliation: Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.|University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.
authors.forename: Mitja
authors.initials: M
authors.lastname: Košnik
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced* / Q000175:diagnosis*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011237:Predictive Value of Tests; D057566:Self Report
chemical_list: D000700:Analgesics