Pérez-Alzate D, Cornejo-García J A, Pérez-Sánchez N, Andreu I, García-Moral A, Agúndez J A, Bartra J, Doña I, Torres M J, Blanca M, Blanca-López N, Canto G
Allergy Service, Infanta Leonor University Hospital, Madrid, Spain.
Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.
J Investig Allergol Clin Immunol. 2017;27(1):32-39. doi: 10.18176/jiaci.0080.
Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors.
Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration.
From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients.
Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.
对化学结构不相关的非甾体抗炎药（NSAIDs）发生药物过敏反应（DHRs）的个体被认为是交叉过敏。这种分类的标志是患者在摄入乙酰水杨酸（ASA）或对其进行激发试验后出现反应。患者在耐受ASA的同时对两种或更多种NSAIDs是否有反应仍有待研究（选择性反应，SRs）。目的：识别对两种或更多种NSAIDs（包括强效COX-1抑制剂）有选择性反应的患者。
对2011年1月至2014年12月期间在西班牙马德里莱昂诺尔公主医院过敏科就诊的对NSAIDs有DHRs的患者进行评估。纳入那些在摄入后1小时内出现两种或更多种速发反应的患者。在确认对ASA耐受后，通过体内和/或体外试验或通过对照给药来证明对两种或更多种NSAIDs反应的选择性。
在总共203例对NSAIDs有速发DHRs的患者中，16例（7.9%）符合纳入标准。这些患者共出现68次过敏或皮肤反应（平均值[标准差]，4.2[2.1]）。大多数反应是针对布洛芬和其他芳基丙酸衍生物以及安乃近。11例患者涉及两种不同的NSAIDs，5例患者涉及三种。
除非证实对ASA耐受，否则不应将NSAID诱导的过敏反应或荨麻疹/血管性水肿患者视为交叉过敏。
