Value of the clinical history in the diagnosis of urticaria/angioedema induced by NSAIDs with cross‐intolerance. Issue 1 (24th December 2012)

• Record Type: Journal Article
• Authors: Blanca‐Lopez, N.; J. Torres, M.; Doña, I.; Campo, P.; Rondón, C.; Seoane Reula, M. E.; Salas, M.; Canto, G.; Blanca, M.
• Is Part Of: Clinical & experimental allergy. Volume 43:Issue 1(2013:Jan.)
• Page Start: 85
• Page End: 91
• Publication Date: 2012-12-24
• Subjects: Allergy -- Periodicals; Immunology -- Periodicals; 616.97
• DOI: 10.1111/cea.12013
• Languages: English
• ISSNs: 0954-7894

Abstract

<abstract abstract-type="main" id="cea12013-abs-0001"> <title>Summary</title> <sec id="cea12013-sec-0001" sec-type="section"> <title>Background</title> <p>Multiple Non‐steroidal anti‐inflammatory drugs <bold>(</bold>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.</p> </sec> <sec id="cea12013-sec-0002" sec-type="section"> <title>Objective</title> <p>To evaluate the role of the clinical history in the diagnosis of multiple NSAID‐induced urticaria/angioedema.</p> </sec> <sec id="cea12013-sec-0003" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="cea12013-sec-0004" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="cea12013-sec-0005" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>