Arikoglu Tuğba, Aslan Gulen, Yildirim Didem Derici, Batmaz Sehra Birgul, Kuyucu Semanur
Department of Pediatric Allergy and Immunology, Mersin University, Faculty of Medicine, Mersin, Turkey.
Department of Pediatrics, Baypark Hospital, İstanbul, Turkey.
Allergol Int. 2017 Jul;66(3):418-424. doi: 10.1016/j.alit.2016.10.004. Epub 2016 Nov 16.
Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently encountered in daily clinical practice. The aim of this study was to determine the confirmation rates, risk factors of NSAID hypersensitivity in children and to try to classify them with a standardized diagnostic protocol.
All patients with a suspicion of NSAID-induced hypersensitivity were evaluated with European Network for drug Allergy (ENDA) recommendations. The children were classified as selective responders (SRs) or cross-intolerant (CI) depending on the drug provocation test (DPT) results.
We evaluated 106 children with a suspicion of NSAID hypersensitivity. NSAID hypersensitivity was confirmed with tests in 31 patients; 4 (12.9%) were diagnosed by skin tests and 27 (87.1%) by DPTs and two patients with a history of anaphylaxis by medical records. Eleven patients (33.3%) were classified as SRs, whereas twenty-two (66.6%) children as CIs. SRs and CIs were further classified as NSAID-induced urticaria/angioedema (n = 8), NSAID-exacerbated cutaneous disease (n = 6) and NSAID-exacerbated respiratory disease (n = 1) and single NSAID-induced urticaria/angioedema and/or anaphylaxis (n = 11). Eight (24.2%) patients could not be categorized according to ENDA/GALEN classification; one CI patient could not be classified based on pathomechanisms, seven CIs could not be categorized based on the underlying disease and clinical manifestations. A reaction within an hour of drug intake (aOR:3.0, 95% confidence interval: 1.18-7.67, p = 0.021), a history with multiple NSAIDs hypersensitivity (aOR:2.9, 95% confidence interval: 1.16-7.60, p = 0.022), and family history of atopy (aOR:4.0, 95% confidence interval: 1.50-10.82, p = 0.006) were found as the independent risk factors related to confirmed NSAID hypersensitivity.
This study suggests the presence of different phenotypes which do not fit into the current classifications in children with NSAID hypersensitivity.
非甾体抗炎药（NSAIDs）超敏反应在日常临床实践中经常遇到。本研究的目的是确定儿童NSAIDs超敏反应的确诊率、危险因素，并尝试用标准化诊断方案对其进行分类。
所有疑似NSAIDs诱导超敏反应的患者均按照欧洲药物过敏网络（ENDA）的建议进行评估。根据药物激发试验（DPT）结果，将儿童分为选择性反应者（SRs）或交叉不耐受者（CI）。
我们评估了106例疑似NSAIDs超敏反应的儿童。31例患者经检测确诊为NSAIDs超敏反应；4例（12.9%）通过皮肤试验确诊，27例（87.1%）通过DPT确诊，2例有过敏反应病史的患者通过病历确诊。11例患者（33.3%）被分类为SRs，而22例（66.6%）儿童被分类为CIs。SRs和CIs进一步分为NSAIDs诱导的荨麻疹/血管性水肿（n = 8）、NSAIDs加重的皮肤病（n = 6）和NSAIDs加重的呼吸道疾病（n = 1）以及单一NSAIDs诱导的荨麻疹/血管性水肿和/或过敏反应（n = 11）。8例（24.2%）患者无法根据ENDA/GALEN分类进行归类；1例CI患者无法根据发病机制进行分类，7例CI患者无法根据基础疾病和临床表现进行归类。药物摄入后1小时内出现反应（调整后比值比：3.0，95%置信区间：1.18 - 7.67，p = 0.021）、有多种NSAIDs超敏反应病史（调整后比值比：2.9，95%置信区间：1.16 - 7.60，p = 0.022）以及特应性家族史（调整后比值比：4.0，95%置信区间：1.50 - 10.82，p = 0.006）被发现是与确诊的NSAIDs超敏反应相关的独立危险因素。
本研究表明，NSAIDs超敏反应儿童中存在不符合当前分类的不同表型。
