J Investig Allergol Clin Immunol. 2015;25(4):259-69.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used worldwide and are responsible for several types of drug hypersensitivity reactions (DHRs) in all age groups. The 2 major groups of DHRs to NSAIDs are those induced by immunological mechanisms (selective reactions) and those where inflammatory mediators are released through activation of the prostaglandin-leukotriene pathway without specific immunological recognition (cross-intolerance). In the present review, we focus on cross-intolerance reactions, which are the most frequent DHRs and are becoming a topic of major interest in children and adolescents. Paracetamol and ibuprofen are the drugs that most frequently cause DHRs in children; other NSAIDs are responsible for reactions in adolescents. In vivo and in vitro tests are of limited diagnostic value, with some exceptions for the less common selective reactions. In cross-intolerance, the clinical history and controlled administration are in many instances the only way to establish a diagnosis and look for alternatives. The clinical history is diagnostic when consistent symptoms occur repeatedly after exposure to NSAIDs with different chemical structures. Cutaneous and respiratory symptoms often co-occur in young children. The natural history of these reactions in children is unknown, and some patients can develop tolerance over time. Atopy remains a major risk factor for cross-intolerant reactions. The increasing interest in hypersensitivity to NSAIDs with improvements in patient phenotyping and the information provided by pharmacogenetics will improve our understanding and management of these reactions in the near future.
非甾体抗炎药（NSAIDs）在全球范围内广泛使用，可导致所有年龄段人群发生多种类型的药物超敏反应（DHR）。DHR 可分为 2 大主要类型，一类是由免疫机制引起的（选择性反应），另一类是通过激活前列腺素-白三烯途径释放炎症介质而引起，没有特定的免疫识别（交叉不耐受）。本综述重点关注交叉不耐受反应，它是最常见的 DHR，在儿童和青少年中已成为一个主要研究课题。在儿童中，对乙酰氨基酚和布洛芬是最常引起 DHR 的药物；在青少年中，其他 NSAIDs 则会引起反应。体内和体外试验的诊断价值有限，对于较少见的选择性反应有一些例外。在交叉不耐受中，临床病史和控制用药在许多情况下是唯一能确诊和寻找替代药物的方法。如果在接触不同化学结构的 NSAIDs 后反复出现一致的症状，则临床病史具有诊断意义。在幼儿中，皮肤和呼吸道症状常同时出现。这些反应在儿童中的自然病程尚不清楚，有些患者可能随时间推移而产生耐受。特应性仍然是交叉不耐受反应的主要危险因素。随着对 NSAIDs 超敏反应的关注度增加，以及患者表型分析和药物遗传学提供的信息的改善，在不久的将来，我们将更好地理解和管理这些反应。
