Diagnostic Evaluation of Hypersensitivity Reactions to Arylpropionic Acid Derivatives: a Descriptive Observational Study Focusing on Clinical Characteristics and Potential Risk Factors in Children

Overview

Journal Int J Clin Pharm

Publisher Springer

Specialties Pharmacology
Pharmacy

Date 2024 Jun 11

PMID 38861048

Authors

Tugba Arikoglu

Nazan Tokmeci

Ali Demirhan

Aylin Kont Ozhan

Aysu Ilhan Yalaki

Veysi Akbey

Semanur Kuyucu

Affiliations

Soon will be listed here.

Abstract

Background: Arylpropionic acid derivatives (APs) are the main triggers of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. Data on clinical patterns and risk factors for AP hypersensitivity in children are quite limited.

Aim: To assess the clinical characteristics and potential risk factors for proven AP hypersensitivity in children.

Method: Patients with a history of AP hypersensitivity were retrospectively assessed using a standardized diagnostic algorithm. Children with confirmed hypersensitivity were defined as selective responders or cross-intolerants based on the result of drug provocation tests and further categorized according to the EAACI/ENDA classification. A multivariable logistic regression analysis was performed to analyze the potential risk factors for proven AP hypersensitivity.

Results: A total of 166 patients (51.2% male, median age of six years) with a history of AP hypersensitivity were included. Ibuprofen (89.2%) was the most frequently reported AP in the patients' histories. The reported hypersensitivity of 40 (22.4%) patients was confirmed by diagnostic testing: eight (13.6%) patients with a history of reaction only to APs and 32 (29.9%) patients with a history of reactions to multiple NSAIDs, including chemically unrelated NSAIDs in addition to APs. Five (12.5%) patients were classified as selective responders and 35 (87.5%) were cross-intolerants. Overall, five (12.5%) of the confirmed cases could not be categorized according to the EAACI/ENDA classification. Older age (aOR: 1.11, 95% CI 1.02-1.21, p = 0.015), chronic urticaria as an underlying disease (aOR: 2.87, 95% CI 1.09-7.54, p = 0.033) and a history of anaphylaxis (aOR: 7.84, 95% CI 1.86-33.04, p = 0.005) were related to confirmed AP hypersensitivity.

Conclusion: Almost a quarter of children and adolescents were confirmed to have AP hypersensitivity. Older age, the presence of chronic urticaria and a history of anaphylaxis were potential risk factors for proven AP hypersensitivity.

References

Mori F, Atanaskovic-Markovic M, Blanca-Lopez N, Gomes E, Gaeta F, Sarti L . A Multicenter Retrospective Study on Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Children: A Report from the European Network on Drug Allergy (ENDA) Group. J Allergy Clin Immunol Pract. 2019; 8(3):1022-1031.e1. DOI: 10.1016/j.jaip.2019.10.049. View

Dona I, Blanca-Lopez N, Torres M, Garcia-Campos J, Garcia-Nunez I, Gomez F . Drug hypersensitivity reactions: response patterns, drug involved, and temporal variations in a large series of patients. J Investig Allergol Clin Immunol. 2012; 22(5):363-71. View

Kowalski M, Asero R, Bavbek S, Blanca M, Blanca-Lopez N, Bochenek G . Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy. 2013; 68(10):1219-32. DOI: 10.1111/all.12260. View

Cousin M, Chiriac A, Molinari N, Demoly P, Caimmi D . Phenotypical characterization of children with hypersensitivity reactions to NSAIDs. Pediatr Allergy Immunol. 2016; 27(7):743-748. DOI: 10.1111/pai.12596. View

Cavkaytar O, Arik Yilmaz E, Karaatmaca B, Buyuktiryaki B, Sackesen C, Sekerel B . Different Phenotypes of Non-Steroidal Anti-Inflammatory Drug Hypersensitivity during Childhood. Int Arch Allergy Immunol. 2015; 167(3):211-21. DOI: 10.1159/000438992. View

Guvenir H, Misirlioglu E, Vezir E, Toyran M, Ginis T, Civelek E . Nonsteroidal anti-inflammatory drug hypersensitivity among children. Allergy Asthma Proc. 2015; 36(5):386-93. DOI: 10.2500/aap.2015.36.3858. View

Arikoglu T, Aslan G, Yildirim D, Batmaz S, Kuyucu S . Discrepancies in the diagnosis and classification of nonsteroidal anti-inflammatory drug hypersensitivity reactions in children. Allergol Int. 2016; 66(3):418-424. DOI: 10.1016/j.alit.2016.10.004. View

Zambonino M, Torres M, Munoz C, Requena G, Mayorga C, Posadas T . Drug provocation tests in the diagnosis of hypersensitivity reactions to non-steroidal anti-inflammatory drugs in children. Pediatr Allergy Immunol. 2013; 24(2):151-9. DOI: 10.1111/pai.12039. View

Jares E, Cardona Villa R, Sanchez-Borges M, De Falco A, Ensina L, Bernstein J . Drug-induced anaphylaxis, elicitors, risk factors, and management in Latin America. J Allergy Clin Immunol Pract. 2019; 8(4):1403-1405.e1. DOI: 10.1016/j.jaip.2019.10.002. View

10.

Bindu S, Mazumder S, Bandyopadhyay U . Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem Pharmacol. 2020; 180:114147. PMC: 7347500. DOI: 10.1016/j.bcp.2020.114147. View

11.

Cavkaytar O, Arga M . NSAID Hypersensitivity in the Pediatric Population: Classification and Diagnostic Strategies. J Asthma Allergy. 2022; 15:1383-1399. PMC: 9527698. DOI: 10.2147/JAA.S267005. View

12.

Kidon M, Blanca-Lopez N, Gomes E, Terreehorst I, Tanno L, Ponvert C . EAACI/ENDA Position Paper: Diagnosis and management of hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) in children and adolescents. Pediatr Allergy Immunol. 2018; 29(5):469-480. DOI: 10.1111/pai.12915. View

13.

Blanca-Lopez N, Soriano V, Garcia-Martin E, Canto G, Blanca M . NSAID-induced reactions: classification, prevalence, impact, and management strategies. J Asthma Allergy. 2019; 12:217-233. PMC: 6690438. DOI: 10.2147/JAA.S164806. View

14.

Walters K, Woessner K . An Overview of Nonsteroidal Antiinflammatory Drug Reactions. Immunol Allergy Clin North Am. 2016; 36(4):625-641. DOI: 10.1016/j.iac.2016.06.001. View

15.

Lee Y, Shin Y, Park H . New phenotypes in hypersensitivity reactions to nonsteroidal anti-inflammatory drugs. Curr Opin Allergy Clin Immunol. 2019; 19(4):302-307. DOI: 10.1097/ACI.0000000000000541. View

16.

Blanca-Lopez N, Somoza-Alvarez M, Bellon T, Amo G, Canto G, Blanca M . NSAIDs hypersensitivity: questions not resolved. Curr Opin Allergy Clin Immunol. 2018; 18(4):291-301. DOI: 10.1097/ACI.0000000000000454. View

17.

Demoly P, Kropf R, Bircher A, Pichler W . Drug hypersensitivity: questionnaire. EAACI interest group on drug hypersensitivity. Allergy. 1999; 54(9):999-1003. DOI: 10.1034/j.1398-9995.1999.00247.x. View

18.

Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P . General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002; 57(1):45-51. View

19.

Brockow K, Garvey L, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo M . Skin test concentrations for systemically administered drugs -- an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. 2013; 68(6):702-12. DOI: 10.1111/all.12142. View

20.

Yilmaz O, Ertoy Karagol I, Bakirtas A, Topal E, Celik G, Demirsoy M . Challenge-proven nonsteroidal anti-inflammatory drug hypersensitivity in children. Allergy. 2013; 68(12):1555-61. DOI: 10.1111/all.12266. View