Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: does age matter?

##plugins.themes.bootstrap3.article.main##

##plugins.themes.bootstrap3.article.sidebar##

Published Jun 27, 2022
DOI: https://doi.org/10.22551/2022.35.0902.10208
Selda Ali Ruxandra Udrea Rama Boustani Ionela-Andreea Puiu Sabina Loredana Corcea Luiza Spiru

Abstract

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are reported to be the leading cause of drug hypersensitivity reactions. The aim of this study was to characterize a cohort of patients with NSAID hypersensitivity and establish if there are any differences between two groups of adult patients, under 55 years old and over 55 years old, and identify safe alternative options. Methods: Patients with NSAID hypersensitivity who were referred to a single tertiary Allergy center from January 2019 to December 2021 were included. Clinical information was obtained from a review of medical records. Results: A total of 135 patients with a history of NSAID-induced hypersensitivity reactions were included, 80 patients under 55 years old and 55 patients older than 55. Most of the patients enrolled were female (80.74%) and the mean age was 50.21 years, ranging from 18 to 78 years old. The time interval between the first reaction and the allergy work-up was longer in the older group (average timeframe 6.87 years) than in the younger group (average timeframe 3.77 years). The main culprit was metamizole in both groups. An oral provocation test to paracetamol was performed in most of the patients who tolerated the intake of 1000 mg, except for 2 patients who developed angioedema. Conclusion: Angioedema was the most encountered symptom in our population. Age does not influence the allergy work-up of patients with a history of NSAID-induced hypersensitivity reactions.  The drug provocation challenge remains the gold standard for finding a suitable alternative in patients with NSAID-induced hypersensitivity.

##plugins.themes.bootstrap3.article.details##

Keywords

NSAID hypersensitivity, drug allergy, oral provocation test, metamizole hypersensitivity

References
1. Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: Prospective analysis of 18 820 patients. Br Med J. 2004; 329(7456):15-9. doi: 10.1136/bmj.329.7456.15.
2. Kowalski ML, Asero R, Bavbek S et al. 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.
3. Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem Pharmacol. 2020; 180:114147. doi: 10.1016/j.bcp.2020.114147.
4. Sánchez-Borges M, Caballero-Fonseca F, Capriles-Hulett A, González-Aveledo L. Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: An update. Pharmaceuticals (Basel). 2010; 3(1):10-18. doi: 10.3390/ph3010010.
5. Wongrakpanich S, Wongrakpanich A, Melhado, K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis. 2018, 9(1):143-150. doi: 0.14336/AD.2017.0306.
6. Asero R, Bavbek S, Blanca M, et al. Clinical management of patients with a history of urticaria/angioedema induced by multiple NSAIDs: an expert panel review. Int Arch Allergy Immunol. 2013; 160(2):126-33. doi: 10.1159/000342424.
7. Wöhrl S. NSAID hypersensitivity - recommendations for diagnostic work up and patient management. Allergo J Int. 2018; 27(4):114-121. doi: 10.1007/s40629-018-0064-0.
8. Demoly P, Kropf R, Bircher A, Pichler WJ. Drug hypersensitivity: questionnaire. EAACI interest group on drug hypersensitivity. Allergy. 1999; 54(9):999-1003. doi: 10.1034/j.1398-9995.1999.00247.x.
9. Brockow K, Garvey LH, Aberer W, et al. Skin test concentrations for systemically administered drugs - An ENDA/EAACI Drug Allergy Interest Group position paper. Allergy Eur J Allergy Clin Immunol. 2013; 68(6):702-12. doi: 10.1111/all.12142.
10. Blanca-López N, Pérez-Sánchez N, Agúndez JA, et al. Allergic reactions to metamizole: Immediate and delayed responses. Int Arch Allergy Immunol. 2016; 169(4):223-30. doi: 10.1159/000444798.
11. R Core Team (2022). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/ [Available at 24.06.2022]
12. Yuenyongviwat A, Chantaravisarut N, Phattarapongdilok W, Koosakulchai V, Jessadapakorn W, Sangsupawanich P. Characteristics and Contributing Factors Related to Nonsteroidal Anti-Inflammatory Drugs Hypersensitivity. Int Arch Allergy Immunol. 2021; 182(2):139-145. doi: 10.1159/000510364.
13. Angeletti F, Meier F, Zöller N, Meissner M, Kaufmann R, Valesky EM. Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) - a retrospective study. J Dtsch Dermatol Ges. 2020; 18(12):1405-1414. doi: 10.1111/ddg.14292.
14. Demir S, Olgac M, Unal D, Gelincik A, Colakoglu B, Buyukozturk S. Evaluation of hypersensitivity reactions to nonsteroidal anti-inflammatory drugs according to the latest classification. Allergy. 2015; 70(11):1461-7. doi: 10.1111/all.12689.
15. https://ec.europa.eu/health/documents. [Available at 24.06.2022]
16. Sipahi Cimen S, Yucel E, Ozceker D, et al. Behind the scene: Paracetamol hypersensitivity in children. Pediatr Allergy Immunol. 2021; 32(1):177-185. doi: 10.1111/pai.13330.
17. Doña I, Pérez-Sánchez N, Eguiluz-Gracia I, et al. Progress in understanding hypersensitivity reactions to nonsteroidal anti-inflammatory drugs. Allergy. 2020; 75(3):561-575. doi: 10.1111/all.14032.
18. 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. doi: 10.2147/JAA.S164806.
How to Cite
Ali, S., Udrea, R., Boustani, R., Puiu, I.-A., Corcea, S. L., & Spiru, L. (2022). Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: does age matter?. Archive of Clinical Cases, 9(2), Arch Clin Cases 2022; 9(2):80-88. https://doi.org/10.22551/2022.35.0902.10208
Issue
Vol. 9 No. 2 (2022)
Section
Original studies

Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.

Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.

Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.

How to Cite

Ali, S., Udrea, R., Boustani, R., Puiu, I.-A., Corcea, S. L., & Spiru, L. (2022). Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: does age matter?. Archive of Clinical Cases, 9(2), Arch Clin Cases 2022; 9(2):80-88. https://doi.org/10.22551/2022.35.0902.10208