Drug-induced anaphylaxis in children: Nonsteroidal anti-inflammatory drugs and drug provocation test

2014 ◽  
Vol 2 (6) ◽  
pp. 825 ◽  
Author(s):  
Luis Felipe Ensina ◽  
Alex Eustaquio de Lacerda ◽  
Djanira Martins de Andrade ◽  
Ligia Machado ◽  
Inês Camelo-Nunes ◽  
...  
Keyword(s):  
Provocation Test ◽  
Drug Induced ◽  
Drug Provocation Test ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Negative predictive value of provocation tests for nonsteroidal anti-inflammatory drugs in children

2020 ◽  
Vol 41 (4) ◽  
pp. 285-289 ◽  
Author(s):  
Ozge Yilmaz Topal ◽  
Kulhas C. Ilknur ◽  
Yagmur T. Irem ◽  
Toyran Muge ◽  
Civelek Ersoy ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Provocation Test ◽  
Allergy Clinic ◽  
Predictive Values ◽  
Pediatric Allergy ◽  
Provocation Tests ◽  
Drug Classes ◽  
Drug Provocation Test ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: After antibiotics, nonsteroidal anti-inflammatory drugs (NSAID) are one of the leading drug classes responsible for hypersensitivity reactions in children. The drug provocation test (DPT) is the criterion standard for diagnosis. Objective: The aim of the present study was to determine the negative predictive values (NPV) of DPTs with NSAIDs in pediatric patients and to evaluate their attitudes toward NSAID use after a negative DPT result. Methods: The study included all patients who had undergone DPTs between January 1, 2014, and December 31, 2018, in our pediatric allergy clinic for suspected NSAID hypersensitivity reaction and who had a negative result for the suspected agent. Those patients who could be contacted were asked whether the patient had used the same drug again since the DPT and, if so, whether he or she had a reaction. Patients who were reported to have had a reaction were invited to the clinic for reevaluation. Based on the findings from this retesting, the NPVs of the DPTs with NSAIDs were calculated. Results: During the 5-year study period, DPT results were negative for 230 suspected agents in 215 patients. Of these, 143 patients (66.5%) were able to be contacted. A total of 108 patients (75.5%) had used the tested NSAIDs at least once after the provocation test, and five patients (4.6%) reported a reaction on reexposure. Four of these patients declined reevaluation, one patient exhibited no reaction in a second DPT. Therefore, the NPV was calculated as 96.3% (94.3% for ibuprofen, and 100% for paracetamol). Conclusion: The NPVs of DPTs with NSAIDs, especially of paracetamol DPT, is high in children. This finding should reassure the parents of patients who may require NSAID therapy again.

Meloxicam and/or Etoricoxib Could Be Administered Safely in Two Equal Doses during an Open Oral Challenge in Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity

2021 ◽  
pp. 1-7
Author(s):  
Dolly Vanessa Rojas-Mejía ◽  
Diana Lucía Silva Espinosa ◽  
Diana Marcela Martínez ◽  
Luis Fernando Ramírez Zuluaga ◽  
Carlos Daniel Serrano Reyes
Keyword(s):  
Drug Hypersensitivity ◽  
Provocation Test ◽  
Descriptive Study ◽  
Oral Challenge ◽  
Oral Drug ◽  
Hypersensitivity Reactions ◽  
Cross Sectional ◽  
Drug Provocation Test ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

<b><i>Background:</i></b> Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) are common. These patients require an effective and safe analgesic alternative. <b><i>Objective:</i></b> The aim of the study was to demonstrate the safety of meloxicam and etoricoxib administered by open oral challenge in 2 equal steps in patients with NSAID hypersensitivity. <b><i>Methods:</i></b> A cross-sectional, descriptive study of patients with a diagnosis of NSAID hypersensitivity who underwent an oral drug provocation test (DPT) with meloxicam or etoricoxib between January 2011 and August 2017 was conducted. The analysis was performed from a database in BD Clinic. <b><i>Results:</i></b> Two hundred and twenty-eight oral provocations were performed with an alternative NSAID (203 with meloxicam and 25 with etoricoxib) in 217 patients with hypersensitivity to NSAIDs. The median age was 38 years. Ninety-eight percent of meloxicam and 100% of etoricoxib DPTs were performed in 2 steps (without previous placebo), and 52% and 64% of meloxicam and etoricoxib DPTs, respectively, were performed with 50% of the therapeutic dose in each step. Tolerance to meloxicam was demonstrated in 192 patients (94.5%) and in 100% of patients receiving etoricoxib. <b><i>Conclusions:</i></b> Open oral provocation with meloxicam and etoricoxib carried out in 2 steps without placebo seems to be safe and implies less costs and less time expenditure. Also, it could be performed with 2 equal doses.

scholarly journals A SIMPLE TOOL FOR RISK STRATIFICATION OF DRUG PROVOCATION TEST WITH NON-STEROIDAL ANTI-INFLAMMATORY DRUG

2020 ◽  
Vol 145 (2) ◽  
pp. AB100
Author(s):  
Nathalia Vital ◽  
Caroline Ferreira ◽  
Raissa Roque ◽  
Alex Lacerda ◽  
Chayanne Araujo ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Provocation Test ◽  
Inflammatory Drug ◽  
Simple Tool ◽  
Drug Provocation Test ◽  
Anti Inflammatory

Sa1558 Risk of Non-Steroidal Anti-Inflammatory Drugs-Related Serious Drug-Induced Liver Injury: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 150 (4) ◽  
pp. S1066
Author(s):  
Sakkarin Chirapongsathorn ◽  
Chayakrit Krittanawong ◽  
Ann M. Farrell ◽  
Mohammad H. Murad ◽  
Patrick Kamath
Keyword(s):  
Systematic Review ◽  
Liver Injury ◽  
Meta Analysis ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals Rofecoxib-Induced Hepatotoxicity: A Forgotten Complication of the Coxibs

2006 ◽  
Vol 20 (5) ◽  
pp. 351-355 ◽  
Author(s):  
Brian Yan ◽  
Yvette Leung ◽  
Stefan J Urbanski ◽  
Robert P Myers
Keyword(s):  
Hepatic Injury ◽  
Hepatic Dysfunction ◽  
Cyclooxygenase 2 ◽  
Liver Histology ◽  
Cardiovascular Safety ◽  
Drug Induced ◽  
Severe Hepatotoxicity ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Rofecoxib is a member of the coxib family of nonsteroidal anti-inflammatory drugs that selectively inhibit cyclooxygenase-2. Although the coxibs are generally well-tolerated, rofecoxib was recently withdrawn from the market due to concerns regarding cardiovascular safety. Rare cases of hepatic injury attributable to the coxibs have been reported. In the present study, two additional cases of severe hepatotoxicity are described in patients with cholestatic symptoms and abnormal liver biochemistry, shortly following the initiation of rofecoxib for arthritic complaints. In both cases, liver histology was compatible with drug-induced hepatotoxicity, and rapid clinical and biochemical improvements were observed following rofecoxib discontinuation. With new coxibs and expanding indications on the horizon, physicians in all areas of practice must be aware of this disorder and consider it in any patient who develops hepatic dysfunction after taking a coxib.

scholarly journals Ketoprofen, an emerging photoallergen

2014 ◽  
Vol 83 (3) ◽  
pp. 260-264
Author(s):  
Ewelina Bogumiła Zuba ◽  
Agnieszka Osmola-Mańkowska ◽  
Dorota Jenerowicz ◽  
Maciej Stawny ◽  
Magdalena Czarnecka-Operacz
Keyword(s):  
Contact Dermatitis ◽  
Positive Reaction ◽  
Topical Application ◽  
Clinical Importance ◽  
Drug Induced ◽  
Detailed Instruction ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Introduction. Ketoprofen, which belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs), is an emerging photoallergen. Especially its topical use may be a cause of drug-induced photosensitivity.Material and methods. We report two cases of photoallergic and one case of phototaggravated contact dermatitis due to topical ketoprofen application, confirmed by photopatch testing.Results. All patients presented positive reactions to ketoprofen at an irradiated site. Only one patient demonstrated a positive reaction to ketoprofen both at an irradiated and non-irradiated site.Conclusions. Photosensitive reactions due to topical application of ketoprofen being of significant clinical importance need to be properly diagnosed. It is crucial to provide patients with a detailed instruction how to protect photoexposed areas during therapy with ketoprofen.

scholarly journals Drug-induced anaphylaxis—elicitors, mechanisms and diagnosis

2019 ◽  
Vol 28 (8) ◽  
pp. 327-329
Author(s):  
Margitta Worm ◽  
Theresa Hanschmann-Mohn ◽  
Kathrin Scherer Hofmeier ◽  
Victòria Cardona ◽  
Paul Turner ◽  
...  
Keyword(s):  
Drug Induced ◽  
International Guidelines ◽  
Provocation Tests ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Drugs are one of the major causes of anaphylaxis. For example 2346 cases of drug-induced anaphylaxis were reported to the anaphylaxis register as of March 2019. The most common triggers of drug-induced anaphylaxis were nonsteroidal anti-inflammatory drugs (NSAIDs; n = 902) and antibiotics (n = 721). Drug-induced anaphylaxis can be caused by IgE-dependent (e.g., penicillins) and IgE-independent mechanisms. Recently MRG-PX2 has been identified as a receptor for non-IgE-dependent mechanisms. Drug-induced anaphylaxis results more frequently in lethal reactions and is more commonly associated with cardiovascular symptoms. Also therapy refractory anaphylaxis is more frequently triggered by drugs. For the diagnosis of drug-induced anaphylaxis current national and international guidelines should be followed including provocation tests to avoid future reactions.

scholarly journals Nonsteroidal Anti-Inflammatory Drug-Induced Severe Hyponatremia

Medicina ◽  
2012 ◽  
Vol 48 (12) ◽  
pp. 90 ◽  
Author(s):  
Mehmet Demir ◽  
Mehmet Horoz ◽  
Turgay Ulas ◽  
Mehmet Eren ◽  
Zafer Ercan
Keyword(s):  
Water Retention ◽  
Serum Sodium Level ◽  
Free Water ◽  
Inhibitory Effect ◽  
Severe Hyponatremia ◽  
Drug Induced ◽  
Water Excretion ◽  
Inflammatory Drug ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Hyponatremia (serum sodium level, <135 mmol/L) occasionally may develop in the course of treatment with nonsteroidal anti-inflammatory drugs, which are usually used in daily clinical practice. Nonsteroidal anti-inflammatory drugs diminish the normal inhibitory effect of prostaglandins on the activity of antidiuretic hormone and can therefore reduce free water excretion, leading to water retention and induction or exacerbation of hyponatremia. In this report, we present a case of hyponatremia in a 78-year-old man who had received meloxicam, a nonsteroidal anti-inflammatory drug.

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