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Allergology Review

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  Authority of Polish Society of Allergology

vol 15. no 3. September 2010  

 Original articles
Immediate hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs). Clinical patterns, reaction types and the concomitant atopy trait
Michał Kurek, Violetta Grycmacher-Łapko, Ewa Janowska, Małgorzata Wiśniewska, Krzysztof Safranow

Background. Six clinical reaction patterns are proposed for immediate
NSAIDs-hypersensitivity. Four are drug unspecific and related
to inhibition of cyclooxygenase enzymes (COX). Two are drug specific
and probably immune mediated. Interestingly, the atopy trait was
observed in subjects with drug specific and drug unspecific hypersensitivity.
Objective. We validated the clinical reliability of the proposed classification
in fifty patients with NSAID-hypersensitivity. The prevalence
of the atopy trait was compared to a group of healthy controls.
Material and methods. Fifty patients and fifty sex- and age-matched
healthy volunteers, were recruited. Hypersensitivity was diagnosed by
a convincing history of symptoms, or aggravations, appearing after
the intake of the same, or another NSAID. When necessary, the causal
relationship was confirmed by a controlled oral challenge. Atopy was
diagnosed only when one or more atopic phenotypes could be identified.
In addition, other parameters such as another IgE-mediated
allergy and one or more positive skin prick tests were registered. The
prevalence of atopy and other parameters was compared using the
Fisher’s exact test
Results. Clinical reaction patterns corresponded to: type 1 (12%);
type 2 (2%); type 3 (18%); type 4 (30%); type 5 (28%), and type
6 reaction (10%). Atopic disease, positive skin prick test to at least
one aeroallergen, and the presence of at least one of these traits
were associated with NSAID hypersensitivity (p=0.016, p=0.041 and
p=0.0018, respectively).
Conclusions. Although the blended reactions of type 4 were identified
in 30% of patients, the proposed classification is of practical
value. The atopic disease and enhanced skin reactivity to potential
aeroallergens are associated with hypersensitivity towards NSAIDs.

keywords: NLPZ, nadwrażliwość, wzorce objawów, anafilaksja, cechy atopii, NSAIDs, hypersensitivity, reaction patterns, anaphylaxis, atopy trait

pages: from 118 to 124

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