BACKGROUND: Multiple Non-steroidal anti-inflammatory drugs (NSAID)-induced urticaria/angioedema is the most common manifestation of hypersensitivity reactions to NSAIDs. Diagnostic evaluation is based on the clinical history and a drug provocation test. OBJECTIVE: To evaluate the role of the clinical history in the diagnosis of multiple NSAID-induced urticaria/angioedema. METHODS: We studied a group of patients with an unequivocal history of urticaria and/or angioedema after NSAID intake. Subjects had to have had at least two episodes of cutaneous symptoms with two different COX-1 inhibitors. The diagnosis was confirmed in all cases by a drug provocation test with acetyl salicylic acid (ASA). Multivariate analysis was done by analysing different variables, including number of drugs involved, episodes and time elapsed between drug intake and symptom onset. RESULTS: Of the total group of 75 cases with multiple NSAID-induced urticaria/angioedema diagnosed according to the clinical history, 76% developed a positive drug provocation test with ASA. The risk for having hypersensitivity was 17 times higher in patients who developed symptoms within the first 60 min after drug intake, 13 times higher in those who experienced reactions with more than two non-chemically related NSAIDs, and 10 times higher in women. CONCLUSIONS: Drug provocation testing with ASA confirms the diagnosis of multiple NSAID-induced urticaria/angioedema in up to 92% of cases with an unequivocal clinical history, when reactions occur within 1 h and more than two different NSAIDs are involved.
BACKGROUND: Multiple Non-steroidal anti-inflammatory drugs (NSAID)-induced urticaria/angioedema is the most common manifestation of hypersensitivity reactions to NSAIDs. Diagnostic evaluation is based on the clinical history and a drug provocation test. OBJECTIVE: To evaluate the role of the clinical history in the diagnosis of multiple NSAID-induced urticaria/angioedema. METHODS: We studied a group of patients with an unequivocal history of urticaria and/or angioedema after NSAID intake. Subjects had to have had at least two episodes of cutaneous symptoms with two different COX-1 inhibitors. The diagnosis was confirmed in all cases by a drug provocation test with acetyl salicylic acid (ASA). Multivariate analysis was done by analysing different variables, including number of drugs involved, episodes and time elapsed between drug intake and symptom onset. RESULTS: Of the total group of 75 cases with multiple NSAID-induced urticaria/angioedema diagnosed according to the clinical history, 76% developed a positive drug provocation test with ASA. The risk for having hypersensitivity was 17 times higher in patients who developed symptoms within the first 60 min after drug intake, 13 times higher in those who experienced reactions with more than two non-chemically related NSAIDs, and 10 times higher in women. CONCLUSIONS: Drug provocation testing with ASA confirms the diagnosis of multiple NSAID-induced urticaria/angioedema in up to 92% of cases with an unequivocal clinical history, when reactions occur within 1 h and more than two different NSAIDs are involved.
Authors: Inmaculada Doña; Esther Barrionuevo; María Salas; José Julio Laguna; José Agúndez; Elena García-Martín; Gádor Bogas; James Richard Perkins; José Antonio Cornejo-García; María José Torres Journal: Sci Rep Date: 2018-11-12 Impact factor: 4.379
Authors: Natalia Pérez-Sánchez; Inmaculada Doña; Gador Bogas; María Salas; Almudena Testera; José A Cornejo-García; María J Torres Journal: Front Pharmacol Date: 2020-04-21 Impact factor: 5.810
Authors: Mohammad Bakhriansyah; Ronald H B Meyboom; Patrick C Souverein; Anthonius de Boer; Olaf H Klungel Journal: Fundam Clin Pharmacol Date: 2019-04-22 Impact factor: 2.748