Rebelo Gomes Eva, Geraldes Luísa, Gaspar Ângela, Malheiro Daniela, Cadinha Susana, Abreu Carmo, Chambel Marta, Almeida Eugénia, Faria Emília
Immunoallergology Department, Centro Hospitalar do Porto EPE, Porto, Portugal.
Int Arch Allergy Immunol. 2016;171(3-4):269-275. doi: 10.1159/000452627. Epub 2017 Jan 4.
Nonsteroidal anti-inflammatory drugs (NSAIDS) are among the most common causes of drug hypersensitivity (HS) reactions. The diagnosis is based on a careful clinical history, and provocation tests are considered the gold standard for diagnosis. Skin tests have some value to study reactions to pyrazolones. Laboratory investigations are mostly used for research purposes. Different phenotypes have been described.
Our aim was to describe the most common clinical manifestations of NSAID HS in a large population of adult patients, the drugs involved, the association with previously described risk factors, and the outcome of diagnostic procedures. The classification of reactions proposed by the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group was adopted.
Acetylsalicylic acid was the drug most often involved in reactions (34%), isolated cutaneous symptoms were the most reported (60%), and immediate reactions (58%) were the most common. There was an overall female predominance (64%) and 35% of the patients were atopic. HS to NSAIDs was confirmed in 21% of the patients. The most common phenotypes encountered among HS patients were NSAID-induced urticaria/angioedema and single-NSAID-induced urticaria/angioedema or anaphylaxis. Logistic regression analysis showed that gender and atopy were not significant risk factors for HS confirmation, but diagnosis depended on the number of previous reactions, the type of reaction, and the time interval between drug intake and reaction.
Only 21% of suspected HS reactions were confirmed after diagnostic workup. Patients describing >1 previous reaction and suffering immediate reactions had a higher probability of a positive investigation.
非甾体抗炎药（NSAIDs）是药物超敏反应（HS）最常见的病因之一。诊断基于详细的临床病史，激发试验被认为是诊断的金标准。皮肤试验对研究吡唑酮类药物的反应有一定价值。实验室检查主要用于研究目的。已描述了不同的表型。
我们的目的是描述大量成年患者中NSAID HS最常见的临床表现、涉及的药物、与先前描述的危险因素的关联以及诊断程序的结果。采用了欧洲变态反应和临床免疫学会（EAACI）药物变态反应兴趣小组提出的反应分类方法。
阿司匹林是最常引发反应的药物（34%），最常报告的是孤立的皮肤症状（60%），最常见的是速发反应（58%）。总体上女性占多数（64%），35%的患者有特应性。21%的患者确诊为NSAIDs超敏反应。HS患者中最常见的表型是NSAID诱发的荨麻疹/血管性水肿以及单一NSAID诱发的荨麻疹/血管性水肿或过敏反应。逻辑回归分析表明，性别和特应性不是确诊HS的显著危险因素，但诊断取决于既往反应的次数、反应类型以及服药与反应之间的时间间隔。
诊断检查后，仅21%的疑似HS反应得到确诊。既往有>1次反应且发生速发反应的患者检查结果呈阳性的可能性更高。
