Silva M I T, Cosme J, Lorenzo C, Virtuoso J, Gomes R, Pedro E, Neves A M, Lopes A
Department of Immunoallergology, Unidade Local de Saúde Santa Maria, Lisbon, Portugal.
Department of Pediatric, Unidade Local de Saúde Santa Maria, Lisbon, Portugal.
Eur Ann Allergy Clin Immunol. 2025 Mar;57(2):77-82. doi: 10.23822/EurAnnACI.1764-1489.299. Epub 2023 May 30.
Non-steroidal anti-inflammatory drugs (NSAID)/analgesics (paracetamol) are among the most common causes of drug hypersensitivity reactions in children, with a reported prevalence of around 0.3% in the pediatric population. Paracetamol and ibuprofen are the most commonly reported culprits in the pediatric population. Our objective was to describe the allergy workup to NSAID/paracetamol of a pediatric population monitored in an allergy outpatient clinic. Retrospective observational study by consulting the medical records of patients evaluated in a pediatric outpatient clinic with history of NSAID/paracetamol, between January 2016 to August 2022. A total of 43 patients have been evaluated for NSAID/paracetamol suspected allergy: 53.5% females, mean age of 9.8 ± 5.1 years, 47.7% atopic. The drugs reported as culprits were: ibuprofen (75.6%), paracetamol (17.8%), metamizole (4.4%) and naproxen (2.2%) and clinical manifestations were mainly urticaria/angioedema and maculopapular exanthema. Skin tests were performed in 7 patients: paracetamol (n = 5) and metamizole (n = 2), which were all negative. Fourty-six drug provocation tests were performed: 28 with the culprit drug and 18 with an alternative one; only 2 were positive (ibuprofen - culprit NSAID group): one immediate periorbital angioedema and one delayed lip edema with oropharyngeal tightness. The investigation of allergy to NSAID/paracetamol in children remains a challenge. In our population, ibuprofen was the most common NSAID reported. There were only 2 (4.3%) mild reactions on DPT. We could allow the use of the culprit NSAID/analgesic in 11 patients and an alternative one in 9 patients. This study highlights the importance of DPT in children for a correct diagnosis of NSAID hypersensitivity and selection of an alternative drug.
非甾体抗炎药（NSAID）/镇痛药（对乙酰氨基酚）是儿童药物过敏反应最常见的原因之一，据报道在儿科人群中的患病率约为0.3%。对乙酰氨基酚和布洛芬是儿科人群中最常报告的罪魁祸首。我们的目的是描述在过敏门诊监测的儿科人群对NSAID/对乙酰氨基酚的过敏检查情况。通过查阅2016年1月至2022年8月在儿科门诊接受评估且有NSAID/对乙酰氨基酚病史的患者的病历进行回顾性观察研究。共有43例患者接受了NSAID/对乙酰氨基酚疑似过敏评估：女性占53.5%，平均年龄9.8±5.1岁，47.7%为特应性体质。报告的罪魁祸首药物有：布洛芬（75.6%）、对乙酰氨基酚（17.8%）、安乃近（4.4%）和萘普生（2.2%），临床表现主要为荨麻疹/血管性水肿和斑丘疹。对7例患者进行了皮肤试验：对乙酰氨基酚（n = 5）和安乃近（n = 2），结果均为阴性。进行了46次药物激发试验：28次使用罪魁祸首药物，18次使用替代药物；仅2次为阳性（布洛芬 - 罪魁祸首NSAID组）：1次为即刻眶周血管性水肿，1次为延迟性唇部水肿伴口咽紧绷感。儿童对NSAID/对乙酰氨基酚过敏的调查仍然是一项挑战。在我们的人群中，布洛芬是最常报告的NSAID。药物激发试验中只有2例（4.3%）出现轻度反应。我们允许11例患者使用罪魁祸首NSAID/镇痛药，9例患者使用替代药物。这项研究强调了药物激发试验在儿童正确诊断NSAID过敏和选择替代药物方面的重要性。
