Value of the clinical history in the diagnosis of urticaria/angioedema induced by NSAIDs with cross-intolerance

• Published in: Clinical and experimental allergy Vol. 43; no. 1; pp. 85 - 91
• Main Authors: Blanca-Lopez, N., J. Torres, M., Doña, I., Campo, P., Rondón, C., Seoane Reula, M. E., Salas, M., Canto, G., Blanca, M.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.01.2013; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Allergic diseases; angioedema; Angioedema - chemically induced; Angioedema - diagnosis; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - immunology; ASA drug provocation test; Aspirin; Biological and medical sciences; clinical history; cross-intolerance; Cyclooxygenase-1; diagnosis; Drug Hypersensitivity - diagnosis; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Hypersensitivity; Immunopathology; Male; Medical sciences; Middle Aged; Multivariate analysis; Nonsteroidal antiinflammatory drugs; NSAID hypersensitivity; Provocation tests; Salicylic acid; Skin allergic diseases. Stinging insect allergies; Urticaria; Urticaria - chemically induced; Urticaria - diagnosis; Young Adult; Drug; Allergy; Immunopathology; Skin disease; clinical history; Urticaria; Hypersensitivity; NSAID hypersensitivity; Non steroidal antiinflammatory agent; Intolerance; angioedema; Angioneurotic edema; Immunology; cross-intolerance; ASA drug provocation test; Diagnosis; Provocation test
• ISSN: 0954-7894; 1365-2222; 1365-2222
• DOI: 10.1111/cea.12013

Summary 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.