儿童非甾体抗炎药过敏的替代药物安全性。

Alternative Drug Safety in Children with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity.

机构信息

Department of Pediatric Allergy/Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey,

Department of Pediatric Allergy/Immunology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.

出版信息

Int Arch Allergy Immunol. 2024;185(10):921-927. doi: 10.1159/000538877. Epub 2024 May 30.

DOI:10.1159/000538877

PMID:38815557

Abstract

INTRODUCTION

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used in the pediatric age group as pain relievers, antipyretics and anti-inflammatory drugs. Since NSAIDs are used in many medical conditions, there is a need for alternative NSAIDs to be used safely in people with hypersensitivity reactions. Selective and partially selective COX-2 inhibitors and weak COX-1 inhibitors are generally used as safe alternative drugs. The aim of this study was to evaluate safe NSAIDs determined by oral provocation tests (OPTs) according to phenotypes in children with NSAID hypersensitivity reactions.

METHODS

The results of the oral provocation test performed with alternative NSAIDs (paracetamol, meloxicam, nimesulide, celecoxib) in patients followed up with the diagnosis of NSAID hypersensitivity reaction in the Pediatric Immunology and Allergy Department between January 2015 and February 2023 were evaluated retrospectively.

RESULTS

During the study period, 91 patients underwent OPTs with 109 alternative drugs 48 (52.7%) of whom were girls, with a median age of 15 years. 91 patients had a history of reactions to 117 drugs. As an alternative NSAID; OPT was performed with paracetamol in 58 patients, meloxicam in 44 patients, nimesulide in 5 patients, and celecoxib in 2 patients. Since 15 patients used paracetamol safely at home, no tests were performed with paracetamol. Reactions were observed in 3 of the 73 patients (4.1%) who underwent OPT with paracetamol and in 2 of the 44 (4.5%) who underwent OPT with meloxicam. Reactions to nimesulide were also observed in the latter 2 patients (2/5, 40%), but they appeared to tolerate celecoxib. No reaction was observed in the 2 patients who were tested with celecoxib.

CONCLUSION

Paracetamol, meloxicam, and nimesulide can be used as safe alternative drugs in most children with NSAID hypersensitivity. Selective COX-2 inhibitors should be tried as an alternative in patients who cannot tolerate them.

摘要

介绍

非甾体抗炎药（NSAIDs）在儿科中常被用作止痛药、退烧药和抗炎药。由于 NSAIDs 被用于许多医疗情况，因此需要寻找替代 NSAIDs，以便在有过敏反应的人群中安全使用。选择性和部分选择性 COX-2 抑制剂和弱 COX-1 抑制剂通常被用作安全的替代药物。本研究旨在评估根据 NSAID 过敏反应患者的表型，通过口服激发试验（OPT）确定的安全 NSAIDs。

方法

回顾性分析 2015 年 1 月至 2023 年 2 月在儿科免疫和过敏科就诊并诊断为 NSAID 过敏反应的患者接受替代 NSAIDs（对乙酰氨基酚、美洛昔康、尼美舒利、塞来昔布）口服激发试验的结果。

结果

研究期间，91 例患者接受了 109 种替代药物的 OPT，其中 48 例（52.7%）为女性，中位年龄为 15 岁。91 例患者有 117 种药物的过敏反应史。作为替代 NSAID，58 例患者接受了对乙酰氨基酚 OPT，44 例患者接受了美洛昔康 OPT，5 例患者接受了尼美舒利 OPT，2 例患者接受了塞来昔布 OPT。由于 15 例患者在家中安全使用了对乙酰氨基酚，因此无需对其进行 OPT。在接受对乙酰氨基酚 OPT 的 73 例患者中有 3 例（4.1%）和接受美洛昔康 OPT 的 44 例患者中有 2 例（4.5%）出现了反应。后 2 例患者（2/5，40%）也对尼美舒利出现了反应，但他们似乎可以耐受塞来昔布。接受塞来昔布 OPT 的 2 例患者均未出现反应。