Department of Pediatric Allergy, School of Medicine, Hacettepe University, Ankara, Turkey.
Allergy. 2015 Feb;70(2):153-60. doi: 10.1111/all.12539.
Nonsteroidal anti-inflammatory drug (NSAID) exacerbated cutaneous disease is defined as the exacerbation of wheals and/or angioedema in patients with a history of chronic spontaneous urticaria (CSU). The objective of this study was to define 'aspirin-hypersensitive' children and adolescents in a clearly defined group of patients with CSU and to describe their clinical features.
Eighty-one children with a history of CSU were enrolled over a 3-year period. The daily or almost daily (>4 days a week) presence of urticaria was defined as 'chronic persistent urticaria' (CPU), while the presence of urticaria for 2-4 days a week was defined as 'chronic recurrent urticaria' (CRU). Single-blind, placebo-controlled provocation tests (SBPCPTs) with aspirin were performed for children with CSU.
Patients with CRU had a longer duration of cutaneous symptoms [1.6 (0.5-4) vs 0.6 (0.3-1.5) years], and stress was less frequently experienced as an eliciting factor in patients with CRU compared with the patients with CPU (P < 0.016, P = 0.024, respectively). SBPCPTs with aspirin revealed that 14 of 58 patients (24%) with CPU and one of 10 patients with CRU (10%) were aspirin hypersensitive. Aspirin hypersensitivity rate was 26.5% in patients <12 years of age. All of the 15 aspirin-hypersensitive patients (aged between 6.6 and 17.4 years), except for three, experienced an unequivocal angioedema of the lips as a positive reaction in SBPCPT.
Nearly a quarter of children and adolescents with CSU were hypersensitive to aspirin. For children with chronic urticaria, determination of NSAID hypersensitivity in a well-controlled clinical setting will help to avoid severe drug hypersensitivity reactions.
非甾体抗炎药（NSAID）诱发的皮肤疾病定义为慢性自发性荨麻疹（CSU）病史患者中荨麻疹和/或血管性水肿的恶化。本研究的目的是在明确的 CSU 患者人群中定义“阿司匹林过敏”儿童和青少年，并描述其临床特征。
在 3 年期间共纳入 81 名有 CSU 病史的儿童。每日或几乎每日（>4 天/周）存在荨麻疹定义为“慢性持续性荨麻疹”（CPU），而每周存在荨麻疹 2-4 天定义为“慢性复发性荨麻疹”（CRU）。对 CSU 儿童进行单盲、安慰剂对照激发试验（SBPCPT），用阿司匹林进行激发。
CRU 患者的皮肤症状持续时间更长[1.6（0.5-4）年比 0.6（0.3-1.5）年]，CRU 患者比 CPU 患者较少因压力作为诱发因素（P<0.016，P=0.024）。用阿司匹林进行 SBPCPT 显示，58 例 CPU 患者中有 14 例（24%）和 10 例 CRU 患者中有 1 例（10%）对阿司匹林过敏。年龄<12 岁的患者中，阿司匹林过敏率为 26.5%。除了 3 例患者之外，所有 15 例（年龄 6.6-17.4 岁）阿司匹林过敏患者在 SBPCPT 中均表现出明确的唇血管性水肿阳性反应。
近四分之一的 CSU 儿童和青少年对阿司匹林过敏。对于慢性荨麻疹患儿，在严格控制的临床环境中确定 NSAID 过敏情况有助于避免严重的药物过敏反应。
