Introduction: Non-steroidal anti-inflammatory drugs
(NSAIDs) are frequently prescribed classes
of drugs and are easily accessible as over-the-counter anti-inflammatory drugs in Singapore. NSAIDs hypersensitivity
is the second most common referral to allergy clinic in a tertiary referral
centre. Methods: Referred patients with history of NSAID intolerance were underwent
open challenge with 1) putative NSAID to confirm the diagnosis; 2) Aspirin to
determine the cross-reactivity or 3) selective cyclooxygenase-2 (COX-2)
inhibitor to identify the suitable alternative. Data were analysed
retrospectively. Results: Over a 4-year period (2010-2014), a total of 127
patients (mean age SD 40.7 /- 15.2) underwent a total of
155 open-labelled labelled NSAIDs oral provocation tests (OPT). Overall
positive challenge rate is 26.5% (41 out of 155). Despite having a clinical relevant
history of causative, only 29.4% (20 out of 68) had positive OPT to putative
NSAIDs. Using selective COX-2 inhibitor challenge for assessing the
tolerability of suitable alternative, we found only 8.8% (5 out of 57) positive
challenge. Conclusions: In our 4-year patients cohort with history of NSAIDs of
intolerance, positive OPT rate of 26.5% in confirming diagnosis of NSAIDs
hypersensitivity. The intolerance to selective COX-2 inhibitor was found in
8.8% of patients with non-steroidal anti-inflammatory drugs hypersensitivity
patients.
Cite this paper
Naing, C. S. and Chong, Y. Y. (2017). Oral Provocation Test in Non-Steroidal Anti-Inflammatory Drug Hypersensitive Patients Referred to Singapore General Hospital. Open Access Library Journal, 4, e3435. doi: http://dx.doi.org/10.4236/oalib.1103435.
Gomes, E.,
Cardoso, M.F.,
Praca, F.,
Gomes, L.,
Marino, E.
and
Demoly, P.
(2004) Self-Reported
Drug Allergy in a General Adult Portuguese Population. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology, 34, 1597-1601. https://doi.org/10.1111/j.1365-2222.2004.02070.x
Nissen, C.V., Bindslev-Jensen, C. and
Mortz, C.G. (2015) Hypersensitivity
to Non-Steroidal
Anti-Inflammatory Drugs (NSAIDs): Classification of a Danish Patient Cohort According
to EAACI/ENDA Guidelines. Clinical and
Translational Allergy, 5, 10. https://doi.org/10.1186/s13601-015-0052-0
Kowalski, M.L., Asero, R., Bavbek, S.,
Blanca, M.,
Blanca-Lopez, N.,
Bochenek, G., et al. (2013) Classification
and Practical Approach to the Diagnosis and Management of Hypersensitivity to
Nonsteroidal Anti-Inflammatory Drugs. Allergy, 68, 1219-1232. https://doi.org/10.1111/all.12260
Sanchez-Borges, M., Caballero-Fonseca, F., Capriles-Hulett, A.
and
Gonzalez-Aveledo, L.
(2010) Hypersensitivity Reactions
to Nonsteroidal Anti-Inflammatory Drugs: An Update. Pharmaceuticals, 3, 10-18. https://doi.org/10.3390/ph3010010
Malskat, W.S.,
Knulst, A.C.,
Bruijnzeel-Koomen, C.A.
and
Rockmann, H.
(2013) Tolerance
to Alternative Cyclooxygenase-2 Inhibitors in Nonsteroidal Anti-Inflammatory
Drug Hypersensitive Patients. Clinical
and Translational Allergy, 3, 20. https://doi.org/10.1186/2045-7022-3-20
Llanora, G.V., Loo, E.X., Gerez, I.F.,
Cheng, Y.K.
and
Shek, L.P. (2013) Etoricoxib:
A Safe Alternative for NSAID Intolerance in Asian Patients. Asian Pacific Journal of Allergy and
Immunology, 31, 330-333. https://doi.org/10.12932/AP0290.31.4.2013
Bavbek, S., Celik, G., Ozer, F.,
Mungan, D.
and
Misirligil, Z.
(2004) Safety
of Selective COX-2 Inhibitors in Aspirin/Nonsteroidal Anti-Inflammatory
Drug-Intolerant Patients: Comparison of Nimesulide, Meloxicam, and Rofecoxib. The Journal of Asthma: Official Journal of the Association for the
Care of Asthma, 41, 67-75. https://doi.org/10.1081/JAS-120026063
Asero, R. and Quaratino, D.
(2013) Cutaneous
Hypersensitivity to Multiple NSAIDs: Never Take Tolerance to Selective COX-2
Inhibitors (COXIBs) for Granted! European
Annals of Allergy and Clinical Immunology, 45, 3-6.
Kim, Y.-J.,
Lim, K.-H.,
Kim, M.-Y.,
Jo, E.-J.,
Lee, S.-Y.,
Lee, S.-E., et al. (2014) Cross-Reactivity
to Acetaminophen and Celecoxib According to the Type of Nonsteroidal
Anti-Inflammatory Drug Hypersensitivity. Allergy, Asthma & Immunology Research, 6, 156-162. https://doi.org/10.4168/aair.2014.6.2.156
Quercia, O., Emiliani, F., Foschi, F.G.
and
Stefanini, G.F. (2008) Safety
of Etoricoxib in Patients with Reactions to NSAIDs. Journal of Investigational Allergology & Clinical Immunology, 18, 163-167.
Warner, T.D.
and
Mitchell, J.A. (2004) Cyclooxygenases:
New Forms, New Inhibitors, and Lessons from the Clinic. FASEB Journal: Official
Publication of the Federation of American Societies for Experimental Biology, 18, 790-804. https://doi.org/10.1096/fj.03-0645rev
Matucci, A.,
Parronchi, P.,
Vultaggio, A.,
Rossi, O.,
Brugnolo, F.,
Maggi, E., et al. (2004) Partial
Safety of the New COX-2 Inhibitor Rofecoxib in NSAIDs High Sensitive Patients. Allergy, 59, 1133-1134. https://doi.org/10.1111/j.1398-9995.2004.00532.x