Greenslopes Private Hospital, Greenslopes, Queensland, Australia.
Intern Med J. 2012 Jun;42(6):665-71. doi: 10.1111/j.1445-5994.2011.02601.x.
Urticaria, angioedema and anaphylaxis are common adverse reactions to non-steroidal anti-inflammatory drugs (NSAIDs).
To investigate the clinical characteristics of NSAID-induced acute hypersensitivity reactions with structured oral drug challenges.
Patients with NSAID-induced urticaria, angioedema or anaphylaxis were challenged with either the homologous NSAID to confirm diagnosis or a heterologous NSAID to investigate cross-reactivity. Data were analysed retrospectively and supplemented by a telephone questionnaire.
Sixty-eight patients (mean age 48.3, 53 females) reported a total of 75 instances of NSAID-induced reactions of which 64% were purely cutaneous and 36% were systemic anaphylaxis. Ibuprofen was the most frequent cause of reactions (35%), however, diclofenac was the most frequent cause of anaphylaxis (48%). Seventeen out of 40 (43%) homologous NSAID challenges were positive; presentation with anaphylaxis or reaction to diclofenac predicted a positive challenge. Only 7 of 28 (25%) of heterologous NSAID challenges were positive. Structured challenges enabled us to identify 23 (34%) patients with selective reactivity to a single NSAID, 19 (28%) patients with cross-reactivity to multiple NSAIDs and 23 (34%) patients in whom NSAID hypersensitivity was not reproduced. Selective reactors presented most often with anaphylaxis and some had a background of beta-lactam antibiotic allergy. Cross-reactive patients often had a background of chronic urticaria and presented with milder reactions.
In the absence of a reliable in vitro test, structured drug challenges allow identification of selective and cross-reactive NSAID hypersensitivity syndromes. NSAID-induced anaphylaxis is often associated with selective hypersensitivity and patients may not need to avoid other NSAIDs.
荨麻疹、血管性水肿和过敏反应是常见的非甾体抗炎药（NSAIDs）不良反应。
通过口服药物激发试验来研究 NSAIDs 诱导的急性超敏反应的临床特征。
对 NSAIDs 诱导的荨麻疹、血管性水肿或过敏反应患者进行 NSAIDs 同源性药物激发试验以明确诊断，或进行 NSAIDs 交叉反应性药物激发试验以评估交叉反应性。本研究采用回顾性数据分析，并通过电话问卷调查进行补充。
68 例（平均年龄 48.3 岁，53 例女性）患者共报告了 75 例 NSAIDs 诱导反应，其中 64%为单纯皮肤反应，36%为全身性过敏反应。布洛芬是最常见的反应原因（35%），但引起过敏反应最常见的是双氯芬酸（48%）。40 例同源性 NSAIDs 药物激发试验中 17 例（43%）为阳性；表现为过敏反应或对双氯芬酸的反应可预测阳性激发试验。28 例异源性 NSAIDs 药物激发试验中仅有 7 例（25%）为阳性。通过结构药物激发试验，我们确定了 23 例（34%）患者对单一 NSAIDs 具有选择性反应，19 例（28%）患者对多种 NSAIDs 具有交叉反应性，23 例（34%）患者 NSAIDs 超敏反应无法重现。选择性反应患者最常表现为过敏反应，其中一些患者有β-内酰胺类抗生素过敏史。交叉反应性患者常伴有慢性荨麻疹，表现为较轻的反应。
在缺乏可靠的体外检测的情况下，结构药物激发试验可识别选择性和交叉反应性 NSAIDs 超敏反应综合征。NSAIDs 诱导的过敏反应常与选择性超敏反应有关，此类患者可能无需避免使用其他 NSAIDs。
