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 Hypersensitivity reactions to non-steroidal anti-inflammatory drugs: results of an Austrian cohort study

2020 ◽  
Vol 29 (7) ◽  
pp. 227-232
Author(s):  
Teresa Bangerl ◽  
Brigitte Zahel ◽  
Andrea Lueger ◽  
Emmanuella Guenova ◽  
Irena Angelova-Fischer ◽  
...  
Keyword(s):  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Provocation Test ◽  
Clinical History ◽  
University Hospital ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Culprit Drug ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Summary Background Hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of drug hypersensitivity. Despite the importance of NSAIDs in routine analgesia only few studies have systematically addressed the question of tolerability in hypersensitive patients. Methods The authors retrospectively analysed 398 patients that were treated at the Department of Dermatology, Kepler University Hospital Linz, Austria, in the period 2012–2016 with a clinical history of NSAID hypersensitivity. Skin tests (skin prick and intracutaneous tests) to common NSAIDs were performed, followed by single-blinded, placebo-controlled drug challenge with either the culprit drug or an alternative NSAID. Results A total of 361 patients were subjected to skin testing. Of these, 25 patients (6.3%) showed a positive reaction to the culprit drug. According to the severity of the reaction in the medical history, 87 patients were exposed orally to the culprit drug (oral provocation test, OPT) after negative skin test and 255 patients received OPT with alternative NSAIDs according to established protocols. OPT with the culprit drug resulted in hypersensitivity reactions in 12 patients (13.79%). In terms of alternative NSAID testing, the three most commonly tested drugs were lornoxicam (192 OPTs), acetaminophen (156 OPTs) and celecoxib (133 OPTs) with tolerability rates in respectively 88.54% (hypersensitivity reactions, 11.46%), 92.31% (hypersensitivity reactions, 7.69%) and 91.73% (hypersensitivity reactions, 8.27%) of cases. Conclusion OPT with alternative NSAIDs are useful in patients with NSAID hypersensitivity as tolerability varies between the individual substances.

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

scholarly journals DRUG PROVOCATION TEST AS A DIAGNOSTIC APPROACH FOR HYPERSENSITIVITY REACTION TO ANTITUBERCULOSIS DRUGS: A REPORT OF TWO CASES

2020 ◽  
pp. 1-4 ◽  
Author(s):  
KETUT SURYANA
Keyword(s):  
Therapeutic Approach ◽  
Patient Adherence ◽  
Drug Hypersensitivity ◽  
Public Health Problem ◽  
Provocation Test ◽  
Hypersensitivity Reactions ◽  
Increased Risk ◽  
Drug Provocation Test ◽  
Drug Hypersensitivity Reactions ◽  
Degrees Of Severity

Pulmonary tuberculosis (PTB) continues to be a public health problem, especially in developing countries. The necessity use of multidrug regimens of antituberculosis drug (ATD) in PTB treatment has been associated with increased risk of drug hypersensitivity reactions (DHRs). DHR is a type of unpredictable reaction, refers to immunologically mediated hypersensitivity reactions. It is observed more frequently in the intensive phase of the PTB treatment with varying degrees of severity. DHR can lead to reduce the patient adherence, thereby leading to stoppage of the drugs by the patient. The definite diagnosis based on drug provocation test (DPT) that should be performed at a hospital. The recommended therapeutic approach is rapid desensitization by reintroducing drugs in safety and optimal under threshold dose until usual daily dose is reached. We present two cases of DHR to ATD, DPT as the diagnosis and rapid desensitization as the therapeutic approach.

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.

scholarly journals Nonsteroidal anti-inflammatory drugs-induced hypersensitivity reactions

2019 ◽  
pp. 411-416
Author(s):  
Andrei Gheorghe Vicovan ◽  
Liliana Veres ◽  
Andrei Cucu ◽  
Dana Turliuc ◽  
Cristina Mihaela Ghiciuc
Keyword(s):  
Drug Hypersensitivity ◽  
Clinical Manifestations ◽  
Clinical Analysis ◽  
In Vitro Tests ◽  
Hypersensitivity Reactions ◽  
Immunological Mechanism ◽  
Immunological Mechanisms ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

The role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in neurosurgical practice is a secondary one, however they are still constantly involved in perioperative management of pain or in nonoperative management of acute radiculopathy. Beside the well-known adverse reactions (ADRs), the neurosurgeon practitioner should also take in account the drug hypersensitivity reactions (DHRs) of NSAIDs and be able to deal with it. The aim of this paper was to review the diagnostic and management steps for NSAIDs-induced Hypersensitivity Reactions. The actual stratification of NSAIDs-induced Hypersensitivity Reactions is based on understanding of the heterogeneity of immunological/non-immunological mechanisms of reactions and complexity of clinical manifestations. Practically, this stratification allows the physician to assess suspicion of DHR, based on anamnesis and clinical analysis, and to consider further practical steps to manage and eventually confirm the diagnosis. Drug allergies are considered only the DHRs for which a definite immunological mechanism (either drug-specific antibody or T cell) is demonstrated. In conclusion, clinical analysis and anamnesis of patient with NSAIDs-induced Hypersensitivity Reactions can be realized by any physician and could be enough to diagnose, but it is not sufficient to confirm the diagnosis. In vitro tests and oral provocation challenges may be necessary to be undertaken by an allergy specialist.

Ipersensibilità ai FANS: intolleranza o allergia?

2021 ◽  
Vol 40 (1) ◽  
pp. 37-43
Author(s):  
Laura Levantino ◽  
Cristiana Corrado ◽  
Laura Badina ◽  
Sara Lega ◽  
Egidio Barbi
Keyword(s):  
Drug Hypersensitivity ◽  
Clinical Manifestations ◽  
Hypersensitivity Reactions ◽  
Provocation Tests ◽  
Immunological Mechanisms ◽  
Drug Hypersensitivity Reactions ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Drug Provocation Tests ◽  
Cox 1

Non-steroidal anti-inflammatory drugs (NSAIDs) are the main triggers of drug hypersensitivity reactions in children. According to the EAACI latest classification NSAIDs hypersensitivity reactions are differentiated into cross-reactive reactions, with non-immunological mechanisms (based on COX-1 inhibition), and selective reactions, with immunological mechanisms. Paediatric clinical manifestations of NSAID hypersensitivity are typically cutaneous, but sometimes, similarly to anaphylaxis, can involve other systems, especially the respiratory one. Differentiating between NSAID intolerance and NSAID allergy through drug provocation tests is crucial for the patient because the two clinical entities require different management.

Short-Term Tolerability of Morniflumate in Patients with Cutaneous Hypersensitivity Reactions to Non-Steroidal Anti-Inflammatory Drugs

2013 ◽  
Vol 26 (1) ◽  
pp. 247-250 ◽  
Author(s):  
F. Mero ◽  
E. Nettis ◽  
A.M. Aloia ◽  
E. Di Leo ◽  
A. Ferrannini ◽  
...  
Keyword(s):  
Drug Hypersensitivity ◽  
Antiinflammatory Drug ◽  
Hypersensitivity Reactions ◽  
Short Term ◽  
Cutaneous Hypersensitivity ◽  
Cutaneous Reactions ◽  
Term Tolerability ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Low Incidence

Morniflumate is the morpholinoethyl ester of niflumic acid, a non-steroidal antiinflammatory drug, derived from nicotinic acid. We studied 112 patients who had experienced cutaneous reactions after using non-steroidal anti-inflammatory drugs. Only two of all the patients who underwent an oral challenge with morniflumate had a positive result to the test. By demonstrating the low incidence of reactions to morniflumate through oral challenges, we suggest that patients with non-steroidal anti-inflammatory drug hypersensitivity may tolerate this drug which would therefore be a useful alternative.

scholarly journals Pharmacogenomics of Hypersensitivity to Non-steroidal Anti-inflammatory Drugs

2021 ◽  
Vol 12 ◽  
Author(s):  
Hoang Kim Tu Trinh ◽  
Le Duy Pham ◽  
Kieu Minh Le ◽  
Hae-Sim Park
Keyword(s):  
Acid Metabolism ◽  
Drug Hypersensitivity ◽  
Methylation Status ◽  
Arachidonic Acid Metabolism ◽  
Hypersensitivity Reactions ◽  
Lipoxygenase Pathway ◽  
Drug Hypersensitivity Reactions ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Larger Sample

Non-steroidal anti-inflammatory drugs (NSAIDs) are extensively prescribed in daily clinical practice. NSAIDs are the main cause of drug hypersensitivity reactions all over the world. The inhibition of cyclooxygenase enzymes by NSAIDs can perpetuate arachidonic acid metabolism, shunting to the 5-lipoxygenase pathway and its downstream inflammatory process. Clinical phenotypes of NSAID hypersensitivity are diverse and can be classified into cross-reactive or selective responses. Efforts have been made to understand pathogenic mechanisms, in which, genetic and epigenetic backgrounds are implicated in various processes of NSAID-induced hypersensitivity reactions. Although there were some similarities among patients, several genetic polymorphisms are distinct in those exhibiting respiratory or cutaneous symptoms. Moreover, the expression levels, as well as the methylation status of genes related to immune responses were demonstrated to be involved in NSAID-induced hypersensitivity reactions. There is still a lack of data on delayed type reactions. Further studies with a larger sample size, which integrate different genetic pathways, can help overcome current limitations of gen etic/epigenetic studies, and provide valuable information on NSAID hypersensitivity reactions.

scholarly journals Analysis of the Costs Associated With the Elective Evaluation of Patients Labelled as Allergic to Beta-Lactams or Nonsteroidal Antiinflamatory Agents

2020 ◽  
Vol 11 ◽  
Author(s):  
Miriam Sobrino-García ◽  
Esther M. Moreno ◽  
Francisco J. Muñoz-Bellido ◽  
Maria T. Gracia-Bara ◽  
Elena Laffond ◽  
...  
Keyword(s):  
Scientific Evidence ◽  
Drug Hypersensitivity ◽  
Hypersensitivity Reactions ◽  
Inclusion Criteria ◽  
Beta Lactams ◽  
Drug Hypersensitivity Reactions ◽  
Clinical Consequences ◽  
Bibliographic Search ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Introduction: Being labelled as allergic to different drugs results in patients receiving other treatments, which are more toxic, less effective and more expensive. We aimed to analyze different studies of the costs of drug hypersensitivity assessment.Methods: A bibliographic search on studies regarding this issue was performed, including the available scientific evidence up to June 2020. We searched three databases with terms related to costs and allergy testing in drug hypersensitivity reactions.Results: Our search revealed 1,430 publications, of which 20 met the inclusion criteria. In the manuscript, prospective studies evaluating the costs of the evaluation of patients with suspected allergy to beta-lactams or non-steroidal anti-inflammatory drugs are analyzed. Also, comment is made on the costs associated with incorrect labeling as non-steroidal anti-inflammatory drug or penicillin hypersensitivity.Conclusions: Taking all costs into account, the study of drug hypersensitivity is not expensive, particularly considering the economic and clinical consequences of labeling a patient with hypersensitivity to drugs.

scholarly journals Prospective study of 5-day challenge with penicillins in children

2020 ◽  
Vol 4 (1) ◽  
pp. e000734
Author(s):  
Birgitte Tusgaard Petersen ◽  
Josefine Gradman
Keyword(s):  
Prospective Study ◽  
Children And Adolescents ◽  
Provocation Test ◽  
Specific Ige ◽  
Hypersensitivity Reactions ◽  
Skin Reactions ◽  
Full Dose ◽  
Culprit Drug ◽  
Drug Provocation Test ◽  
Registration Number

ObjectivesTo examine if a 5-day challenge with penicillin improves the diagnostic sensitivity compared with a single full dose in children with mild skin reactions.DesignSubjects referred with suspected allergy to penicillin were consecutively included. Irrespectively of the morphology of the index reaction and the result of specific IgE, all subjects underwent a two-step titrated drug provocation test (DPT) with the culprit drug followed by a 5-day challenge at home.ParticipantsChildren and adolescents aged 0–18 years referred to allergic workup for penicillin hypersensitivity at two paediatric Danish centres. Only subjects with non-severe skin reactions were included.ResultsA total of 305 subjects were included and 22 (7%) of the DPTs were positive. Three subjects reacted within 1 hour of the first full dose and nine reacted 1–8 hours after the first full dose. Additional 10 positive reactions were observed during the prolonged provocation. Seven subjects reacted after the second full dose and three reacted after 3–6 days. Only mild skin rashes were observed. Eighteen subjects had a specific IgE to a penicillin >0.1 kU/L. Only one of these had a positive DPT.ConclusionIn children, a DPT with penicillins should include at least two full doses. In children with mild hypersensitivity reactions it may be safe to perform DPTs despite a low specific IgE.Trial registration numberNCT04331522

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