Allergy Service, Carlos Haya Hospital, Malaga, Spain.
Allergy. 2014 Apr;69(4):438-44. doi: 10.1111/all.12335. Epub 2013 Dec 23.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent medicaments involved in drug hypersensitivity reactions, with NSAID-induced urticaria/angioedema (NIUA) being the most frequent clinical entity. The natural evolution of NIUA has been suggested to lead to chronic urticaria (CU) in an important proportion of patients, such that NIUA may therefore precede CU. Our aim was to verify whether these entities are related by following up a large cohort of patients with NIUA as well as a control group over a long period of time.
The study comprised three groups: (i) patients with a confirmed history of NIUA (more than two episodes with at least two different NSAIDs or positive drug provocation tests), (ii) patients with more than two episodes of urticaria/angioedema to a single NSAID with good tolerance to a strong COX-1 inhibitor and/or evidence by in vivo tests supporting specific IgE antibodies to the drug (single NSAID-induced urticaria/angioedema, SNIUA), and (iii) controls who tolerated NSAIDs. All cases in the three groups were followed up over a period of 12 years.
There were 190 patients with NIUA (64.6% female; mean age 43.71 ± 15.82 years, 110 with SNIUA, and 152 controls. At the 12-year evaluation, 12 patients with NIUA (6.15%) had developed CU over a 1- to 8-year period. Similar proportions were seen in SNIUA and controls.
Nonsteroidal anti-inflammatory drugs-induced urticaria/angioedema does not seem to precede the onset of CU over the medium term. Further research including a longer follow-up is necessary to verify this observation.
非甾体抗炎药（NSAIDs）是最常见的与药物过敏反应相关的药物，其中 NSAID 诱导的荨麻疹/血管性水肿（NIUA）是最常见的临床实体。NIUA 的自然病程被认为会导致相当一部分患者发生慢性荨麻疹（CU），因此 NIUA 可能先于 CU 发生。我们的目的是通过对大量 NIUA 患者以及对照组进行长期随访，验证这两种疾病是否存在关联。
该研究包括三组人群：（i）确诊有 NIUA 病史的患者（至少两次发作，且至少使用过两种不同的 NSAIDs 或药物激发试验阳性），（ii）单次 NSAID 诱导的荨麻疹/血管性水肿（SNIUA）患者，其在两次以上发作中有一次以上发作，对强 COX-1 抑制剂具有良好耐受性和/或体内试验证实对药物特异性 IgE 抗体（对单一 NSAID 有良好耐受性），以及（iii）能耐受 NSAIDs 的对照组。三组患者均随访 12 年。
共有 190 例 NIUA 患者（64.6%为女性；平均年龄 43.71±15.82 岁）、110 例 SNIUA 患者和 152 例对照组患者纳入研究。在 12 年的评估中，12 例 NIUA 患者（6.15%）在 1 至 8 年内发展为 CU。SNIUA 和对照组患者的比例相似。
在中期，NSAID 诱导的荨麻疹/血管性水肿似乎不会先于 CU 发病。需要进一步研究，包括更长时间的随访，以验证这一观察结果。
