Hassani Amale, Ponvert Claude, Karila Chantal, Le Bourgeois Muriel, De Blic Jacques, Scheinmann Pierre
Pediatric Service, Military Hospital Mohamed V, Rabat-Salé, Morocco.
Eur J Dermatol. 2008 Sep-Oct;18(5):561-5. doi: 10.1684/ejd.2008.0480. Epub 2008 Aug 8.
Hypersensitivity to cyclooxygenase (COX) inhibitors is rare in children. We studied 164 children reporting 213 reactions to paracetamol, ibuprofen and/or acetylsalicylic acid (ASA). Most reactions were cutaneous, either isolated or associated with respiratory symptoms and/or anaphylaxis. Based on a convincing clinical history or positive responses in challenges with the drug(s), hypersensitivity to one or several drug(s) was diagnosed in 49.4% of the children (60, 76.5 and 23.2% of the children reporting reactions to ASA, ibuprofen and paracetamol respectively). Cross-reactivity between nonsteroidal anti-inflammatory drugs (NSAIDs) was frequent (69.1%), but only 10.6% of the NSAID-sensitive children reacted to paracetamol. In contrast, all paracetamol-sensitive children reacted to NSAIDs. Anaphylaxis, immediate and accelerated reactions, atopy, older age and chronic/recurrent urticaria were risk factors for hypersensitivity and/or cross-reactivity between ASA, ibuprofen and paracetamol. In conclusion, hypersensitivity to COX inhibitors was frequent, especially in children reporting severe and/or immediate and accelerated reactions, and in older and atopic children. Cross-reactivity was frequent, suggesting that most reactions resulted from a non allergic hypersensitivity linked to the pharmacological properties of the drugs. However, in a few children, the reactions may result from allergic hypersensitivity to selective (families of) drugs, with tolerance to other drugs.
儿童对环氧化酶（COX）抑制剂过敏的情况较为罕见。我们对164名儿童进行了研究，这些儿童报告了213次对扑热息痛、布洛芬和/或阿司匹林（ASA）的反应。大多数反应为皮肤反应，可为孤立性或伴有呼吸道症状和/或过敏反应。根据令人信服的临床病史或药物激发试验的阳性反应，49.4%的儿童被诊断为对一种或几种药物过敏（分别有60%、76.5%和23.2%报告对ASA、布洛芬和扑热息痛有反应的儿童）。非甾体抗炎药（NSAIDs）之间的交叉反应很常见（69.1%），但只有10.6%对NSAIDs敏感的儿童对扑热息痛有反应。相反，所有对扑热息痛敏感的儿童对NSAIDs都有反应。过敏反应、速发和速发加剧反应、特应性、年龄较大以及慢性/复发性荨麻疹是ASA、布洛芬和扑热息痛之间过敏和/或交叉反应的危险因素。总之，对COX抑制剂过敏很常见，尤其是在报告有严重和/或速发和速发加剧反应的儿童以及年龄较大和有特应性的儿童中。交叉反应很常见，这表明大多数反应是由与药物药理特性相关的非过敏性超敏反应引起的。然而，在少数儿童中，反应可能是由对选择性（一类）药物的过敏性超敏反应引起的，而对其他药物耐受。
