Abstract

CARDOSO, Bárbara Kong; TOMAZ, Elza; CORREIA, Sara  and  INACIO, Filipe. Hypersensitivity to nonsteroidal anti-inflammatory drugs revisited - Clinical and laboratory data considering the new EAACI Classification. Rev Port Imunoalergologia [online]. 2016, vol.24, n.3, pp.163-175. ISSN 0871-9721.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) represent the second most common cause of drug hypersensivity (0.6-5.7% of general population). The wide spectrum of symptoms, the various mechanisms involved and the lack of efficient diagnosing methods turn it into a challenge to the allergist. Objective: The aim of this study was to classify a group of patients with a history of NSAID hypersensitivity according to the system proposed by the EAACI Task Force on NSAIDs Hypersensitivity, to characterize the resulting groups and to evaluate clinical and laboratory data accordingly. Material and methods: Medical records of 64 patients referred to our Centre between 2010 and 2015 and investigated for NSAID hypersensitivity with a basophil activation test (BAT) performed were investigated and classified: group 1- NSAIDs-exacerbated respiratory disease; group 2 - NSAIDs-exacerbated cutaneous disease NSAIDs; group 3 - induced urticaria/angioedema; group 4 - Single-NSAID-induced urticaria/angioedema or anaphylaxis. Demographic and clinical data as well as skin tests, challenge tests and BAT results were analysed. Results: We were able to classify 59 out of 64 patients. Atopy prevalence was significantly higher in group 3 (50%) than in group 4 (5%), p=0,027. The records showed 3 positive provocation tests to nimesulide and 1 to celecoxib. Metamizol was the culprit drug of 54% group 4 reactions and 56% of overall anaphylactic reactions. Skin tests and BAT positivity taken together could identify 11 (79%) of patients reacting to metamizol in group 4. Conclusions: Most of our study patients fitted into the proposed classification. We underline the role of provocation tests to find a safe alternative NSAID and also the efficiency of skin tests and BAT in the diagnosis of metamizol hypersensitivity as single NSAID offender

Keywords : Nonsteroidal anti-inflammatory drugs; basophil activation test; classification; hypersensitivity.

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