Clinical Characteristics and Predictors of Non-Steroidal Anti-Inflammatory Drug (NSAID) Hypersensitivity in Thailand
Division of Allergy Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University
Title :
Clinical Characteristics and Predictors of Non-Steroidal Anti-Inflammatory Drug (NSAID) Hypersensitivity in Thailand
Researcher (s) :
Porntip Intapiboon
Wannada Laisuan
Ticha Rerkpattanapipat
Background : Non-Steroidal Anti-inflammatory Drug (NSAID) is one of the most common drug hypersensitivity (DHR). Main mechanism is NSAID cross-reactivity and the manifestation varies among different ethnics. Drug provocation tests is considered the ‘gold standard’ diagnostic tool, but in some countries which cannot performed DPT due to lack of allergist. If we able to clarify the predictors of NSAID hypersensitivity, it benefit for non-allergist for further most appropriated NSAID use.
Objective : To evaluate clinical characteristics and the factors that predict true NSAID hypersensitivity.
Material and Methods : Retrospective study of 80 patients with suspected NSAID hypersensitivity at Allergy Immunology and Rheumatology (AIR) unit, Ramathibodi hospital, Mahidol university, from Jan 2012 to Dec 2016,Questionnaire according to European Network for Drug allergy (ENDA) and drug provocation test (DPT) results were reviewed. All patients were asked to complete allergy questionnaire. If any respiratory symptom presented, SPT or sIgE for common aeroallergen were performed. Definite NSAID hypersensitivity were either cutaneous reaction from ≥ 3 NSAIDs or positive DPT. Predictors of NSAID hypersensitivity by comparison between definite group and negative DPT group were evaluated.
Result : 80 patients included, 48 patients were classified as definite NSAID hypersensitivity, 19 patients without NSAID hypersensitivity (negative DPT) and 13 with incomplete testing. Most common culprit was Ibuprofen (43.8%) and most common cutaneous reaction was isolated angioedema (50%).From multivariate analysis result, reaction to multiple NSAIDs is a strong predictor of NSAID hypersensitivity.
Conclusions : Isolated angioedema is the most common cutaneous reaction of NSAID hypersensitivity. Reaction to multiple NSAID is the best predictor of NSAID hypersensitivity. Carefully using NSAID in this group is essentials.
Key Contact Person :
Ticha Rerkpattanapipat, MD.
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University
