TOPLINE

In children and adolescents with suspected hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs), only about one third had confirmed NSAID hypersensitivity/allergy.

METHODOLOGY

• Researchers in Italy prospectively evaluated data of 336 children and adolescents (mean age, 9.9 years; 43.8% girls) with a history of hypersensitivity reactions to NSAIDs between January 2015 and December 2024.
• Reactions that occurred at or before 6 hours since the last NSAID administration were classified as immediate, whereas those that occurred after 6 hours of dosing were classified as delayed; reactions occurring at or before 5 years and after 5 years before allergy testing were considered recent and non-recent, respectively.
• Patients with immediate reactions underwent skin prick tests with the suspected NSAIDs and food allergens, followed by drug challenges with the suspected NSAIDs and/or alternative COX-1 inhibitors, according to international guidelines.
• Patients with positive skin prick tests to foods underwent further testing and oral food challenges to determine food hypersensitivity or tolerance. Those with cutaneous and/or anaphylactic reactions were evaluated for NSAID-exacerbated food allergy/NSAID-induced food allergy.
• Reactions were classified based on medical records or parents/caregivers’ descriptions, and patients with two or more reactions with different morphologic characteristics (eg, urticaria and urticaria/angioedema/anaphylaxis [UAA]) were classified according to the most severe reaction.

TAKEAWAY

• Among 336 patients, 73.8% had a history of single NSAID-induced UAA and 15.8% had NSAID-induced UAA, whereas 57.4% had allergic or allergy-like conditions.
• NSAID hypersensitivity/allergy was diagnosed in 31% of patients, with the most frequent phenotypes being single NSAID-induced UAA (55.8%) and NSAID-induced UAA (22.1%), and 3.8% were diagnosed with single-NSAID-induced delayed hypersensitivity reaction.
• Patients experienced 463 reactions to NSAIDs, of which 417 were immediate and 46 were delayed. Of these reactions, 60.7% occurred following the use of NSAIDs as antipyretics, whereas 39.3% were associated with their use as analgesics and/or anti-inflammatory agents.
• Of the 463 reactions, 59.8% were classified as non-hypersensitive/allergic reactions, of which 57% were attributed to ibuprofen and 34.7% to paracetamol. Non-hypersensitive/allergic reactions were associated with the use of NSAIDs as antipyretics (odds ratio [OR], 5.92; 95% CI, 3.60-9.72), urticaria (OR, 3.06; 95% CI, 1.77-5.28), and younger age (OR per 6-year increment, 0.64; 95% CI, 0.47-0.89).

IN PRACTICE

“The present study is the first to investigate and demonstrate in children with a history of hypersensitivity reactions to NSAIDs that the latter can also play a significant role as an aggravating factor of hypersensitivity reactions to foods and, mainly, as a cofactor that elicits symptoms in subjects with food sensitization,” the authors wrote.

SOURCE

Rocco L. Valluzzi, MD, with the Bambino Gesù Children’s Hospital, Rome, Italy, was the corresponding author of the study, which was published online on July 7 in The Journal of Allergy and Clinical Immunology: In Practice.

LIMITATIONS

The researchers did not perform drug challenges with the suspected NSAIDs together with the ingestion of the relevant foods in patients with NSAID-exacerbated food allergy//NSAID-induced food allergy.

DISCLOSURES

This study received partial support through Current Research funds from the Italian Ministry of Health. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.