Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany.
J Dtsch Dermatol Ges. 2020 Dec;18(12):1405-1414. doi: 10.1111/ddg.14292. Epub 2020 Sep 28.
The aim of this study was to verify the validity of clinical history and oral provocation challenges of patients with NSAID hypersensitivity and to identify safe alternatives. The COX-2 inhibitor etoricoxib, in particular, was studied.
In all, 104 patients with confirmed diagnoses of NSAID hypersensitivity treated at the Department of Dermatology, Frankfurt University Hospital, Germany between 2004 and 2012 were retrospectively studied.
The medical history and hypersensitivity symptoms during oral provocation testing (OPT) largely coincided and were mostly mild to moderate. Acetylsalicylic acid (ASA) was the most frequent trigger both anamnestically (27.9 %) and during OPT (47.8 %). Etoricoxib caused the fewest reactions during OPT (4.2 %). Acetaminophen led to reactions in only 6.7 % of the cases studied although it was named more often in clinical histories (14 %).
OPT should be the aim whenever possible as most symptoms are mild to moderate. To distinguish between selective and cross-hypersensitivity reactions, ASA should be part of the test protocol. Furthermore, the findings of this study indicate that etoricoxib and acetaminophen are safe treatment alternatives in case of NSAID hypersensitivity. However, these drugs should not be administered without prior OPT in an inpatient setting, as severe symptoms can occur.
本研究旨在验证 NSAID 过敏患者的临床病史和口服激发挑战的有效性，并确定安全的替代药物。本研究特别研究了 COX-2 抑制剂依托考昔。
回顾性研究了 2004 年至 2012 年期间在德国法兰克福大学医院皮肤科接受 NSAID 过敏诊断的 104 例患者。
病史和口服激发试验（OPT）中的过敏症状大部分一致，且大多为轻至中度。乙酰水杨酸（ASA）在病史（27.9%）和 OPT（47.8%）中均为最常见的触发因素。在 OPT 中，依托考昔引起的反应最少（4.2%）。尽管在病史中被提及的频率更高（14%），但在研究中，对乙酰氨基酚导致反应的病例仅为 6.7%。
只要有可能，就应将 OPT 作为目标，因为大多数症状为轻至中度。为了区分选择性和交叉过敏反应，ASA 应纳入测试方案。此外，本研究的结果表明，依托考昔和对乙酰氨基酚是 NSAID 过敏的安全治疗选择。但是，这些药物不应在住院环境中未经 OPT 就给药，因为可能会出现严重的症状。
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