Allergy Unit, Regional University Hospital of Malaga-IBIMA, Malaga, Spain.
Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Malaga, Spain.
Allergy. 2017 Sep;72(9):1346-1355. doi: 10.1111/all.13147. Epub 2017 Mar 20.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent triggers of drug hypersensitivity with NSAIDs-induced urticaria/angioedema (NIUA) the most common phenotype. Loss of hypersensitivity has been reported for IgE-mediated reactions; however, it has not been assessed in nonimmunological reactions such as NIUA. We evaluated NSAID-hypersensitivity over time in NIUA patients.
Patients confirmed as NIUA by positive drug provocation test (DPT) with acetylsalicylic acid (ASA) during 2005-2012 (V1) were included (n=38). Subjects were prospectively re-evaluated by DPT with ASA/other NSAIDs at two time points between 2013 and 2015 (V2 and V3). Atopy was assessed by skin prick test (SPT) using inhalant and food allergens.
Patients were evaluated at V1 and re-evaluated after 60 months (V2; IR:48-81) and a further 18 months (V3; IR:14-24). At V2, the majority (24; 63.15%) tolerated ASA and other NSAIDs (Group A) while 14 (36.84%) still reacted (Group B). At V3, all Group A patients remained tolerant; all Group B patients remained hypersensitive. The number of previous episodes reported at V1 and the percentage of reactions induced by ASA/ibuprofen were significantly lower in Group A (P=.005 and P=.006, respectively). Group A patients developed tolerance 72 months (IR:45-87) after their last evaluated reaction (V1); this interval was shorter in nonatopics (P=.003), patients who experienced reactions over 1 hour after NSAIDs administration (P=.001), and those who experienced isolated urticaria after NSAID intake (P=.024).
NIUA patients may develop tolerance to NSAIDs over time, a process that seems to be influenced by atopy and type of clinical reaction.
非甾体抗炎药（NSAIDs）是药物过敏反应中最常见的触发因素，其中 NSAIDs 诱导的荨麻疹/血管性水肿（NIUA）是最常见的表型。已报道 IgE 介导的反应会失去过敏反应，但在非免疫性反应如 NIUA 中尚未评估。我们评估了 NIUA 患者随时间推移的 NSAID 过敏反应。
纳入 2005-2012 年期间通过乙酰水杨酸（ASA）药物激发试验（DPT）确诊为 NIUA 的患者（n=38）。在 2013 年至 2015 年期间，通过 ASA/其他 NSAIDs 的 DPT 对受试者进行了前瞻性再评估，分为两个时间点（V2 和 V3）。采用皮肤点刺试验（SPT）评估吸入性和食物过敏原的过敏症。
患者在 V1 时进行评估，在 60 个月（V2；IR：48-81）和 18 个月（V3；IR：14-24）后进行重新评估。在 V2 时，大多数（24；63.15%）患者耐受 ASA 和其他 NSAIDs（A 组），而 14 例（36.84%）仍有反应（B 组）。在 V3 时，所有 A 组患者仍耐受；所有 B 组患者仍过敏。在 V1 时报告的既往发作次数和 ASA/布洛芬诱导反应的百分比在 A 组显著较低（P=.005 和 P=.006）。A 组患者在 V1 最后一次评估后 72 个月（IR：45-87）出现耐受；非过敏患者（P=.003）、NSAIDs 给药后 1 小时以上出现反应的患者（P=.001）和 NSAIDs 摄入后仅出现荨麻疹的患者（P=.024）的间隔时间较短。
NIUA 患者随时间推移可能会对 NSAIDs 产生耐受性，这一过程似乎受到过敏症和临床反应类型的影响。
