Early presentation with angioedema and urticaria in cross-reactive hypersensitivity to nonsteroidal antiinflammatory drugs among young, Asian, atopic children
Objective. Nonsteroidal antiinflammatory drugs (NSAIDs), mainly ibuprofen, are used extensively among children as analgesic and antipyretic agents. Our initial survey in the Kendang Kerbau Children's Hospital in Singapore showed NSAIDs to be the second most common adverse drug reaction-causing...
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| Veröffentlicht in: | Pediatrics (Evanston) 2005-11, Vol.116 (5), p.1208 |
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| creator | Kidon, Mona Iancovici Kang, Liew Woei Chin, Chiang Wen Hoon, Lim Siok See, Yvonne Goh, Anne Lin, Jenny Tang Poh Chay, Oh Moh |
| description | Objective. Nonsteroidal antiinflammatory drugs (NSAIDs), mainly ibuprofen, are used extensively among children as analgesic and antipyretic agents. Our initial survey in the Kendang Kerbau Children's Hospital in Singapore showed NSAIDs to be the second most common adverse drug reaction-causing medications among children of Asian descent. We attempted to characterize the clinical and epidemiologic profile of NSAID reactions in this group of patients. Methods. A retrospective case series from a hospital-based pediatric drug allergy clinic was studied. A diagnosis of NSAID hypersensitivity was made with a modified oral provocation test. Atopy was evaluated clinically and tested with a standard panel of skin-prick tests. We excluded from analysis patients with any unprovoked episodes of urticaria and/or angioedema, patients |
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Nonsteroidal antiinflammatory drugs (NSAIDs), mainly ibuprofen, are used extensively among children as analgesic and antipyretic agents. Our initial survey in the Kendang Kerbau Children's Hospital in Singapore showed NSAIDs to be the second most common adverse drug reaction-causing medications among children of Asian descent. We attempted to characterize the clinical and epidemiologic profile of NSAID reactions in this group of patients. Methods. A retrospective case series from a hospital-based pediatric drug allergy clinic was studied. A diagnosis of NSAID hypersensitivity was made with a modified oral provocation test. Atopy was evaluated clinically and tested with a standard panel of skin-prick tests. We excluded from analysis patients with any unprovoked episodes of urticaria and/or angioedema, patients <1 year of age, and patients who refused a diagnostic challenge test. Results. Between March 1, 2003, and February 28, 2004, 24 patients, including 14 male patients (58%) and 18 Chinese patients (75%), with a mean age of 7.4 years (range: 1.4-14.4 years), were diagnosed as having cross-reactive NSAID hypersensitivity. A family history consistent with NSAID hypersensitivity was elicited for 17% of patients. None of the patients reported any episodes of angioedema/urticaria unrelated to NSAIDs. The median cumulative reaction-eliciting dose was 7.1 mg/kg. Facial angioedema developed for all patients (100%) and generalized urticaria for 38% of challenged patients, irrespective of age. There was no circulatory compromise, but respiratory symptoms of tachypnea, wheezing, and/or cough were documented for 42% of patients. A cross-reactive hypersensitivity response to acetaminophen was documented for 46% of our patients through their history and for 25% through diagnostic challenge. Compared with patients with suspected adverse drug reactions to antibiotics, patients in the NSAID group were older (7.4 vs 4.8 years) and more likely to have a diagnosis of asthma (odds ratio: 7.5; 95% confidence interval: 3.1-19). Conclusions. Early presentations of facial angioedema and urticaria are key features of dose- and potency-dependent, cross-reactive reactions to NSAIDs in a subpopulation of young, Asian, atopic children. Significant overlap with acetaminophen hypersensitivity, especially among very young patients, for whom the use of a cyclooxygenase-2-specific medication may not be feasible, severely limits options for medical antipyretic treatment. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2005-0969; nonsteroidal antiinflammatory drug, children, urticaria, atopy, angioedema.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Evanston: American Academy of Pediatrics</publisher><subject>Adverse and side effects ; Adverse drug reactions ; Angioedema ; Angioneurotic edema ; Asian people ; Children & youth ; Complications and side effects ; Drug therapy ; Drugs ; Inflammatory diseases ; Nonsteroidal anti-inflammatory agents ; Nonsteroidal anti-inflammatory drugs ; Pediatrics ; Risk factors ; Side effects</subject><ispartof>Pediatrics (Evanston), 2005-11, Vol.116 (5), p.1208</ispartof><rights>COPYRIGHT 2005 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Nov 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids></links><search><creatorcontrib>Kidon, Mona Iancovici</creatorcontrib><creatorcontrib>Kang, Liew Woei</creatorcontrib><creatorcontrib>Chin, Chiang Wen</creatorcontrib><creatorcontrib>Hoon, Lim Siok</creatorcontrib><creatorcontrib>See, Yvonne</creatorcontrib><creatorcontrib>Goh, Anne</creatorcontrib><creatorcontrib>Lin, Jenny Tang Poh</creatorcontrib><creatorcontrib>Chay, Oh Moh</creatorcontrib><title>Early presentation with angioedema and urticaria in cross-reactive hypersensitivity to nonsteroidal antiinflammatory drugs among young, Asian, atopic children</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Objective. Nonsteroidal antiinflammatory drugs (NSAIDs), mainly ibuprofen, are used extensively among children as analgesic and antipyretic agents. Our initial survey in the Kendang Kerbau Children's Hospital in Singapore showed NSAIDs to be the second most common adverse drug reaction-causing medications among children of Asian descent. We attempted to characterize the clinical and epidemiologic profile of NSAID reactions in this group of patients. Methods. A retrospective case series from a hospital-based pediatric drug allergy clinic was studied. A diagnosis of NSAID hypersensitivity was made with a modified oral provocation test. Atopy was evaluated clinically and tested with a standard panel of skin-prick tests. We excluded from analysis patients with any unprovoked episodes of urticaria and/or angioedema, patients <1 year of age, and patients who refused a diagnostic challenge test. Results. Between March 1, 2003, and February 28, 2004, 24 patients, including 14 male patients (58%) and 18 Chinese patients (75%), with a mean age of 7.4 years (range: 1.4-14.4 years), were diagnosed as having cross-reactive NSAID hypersensitivity. A family history consistent with NSAID hypersensitivity was elicited for 17% of patients. None of the patients reported any episodes of angioedema/urticaria unrelated to NSAIDs. The median cumulative reaction-eliciting dose was 7.1 mg/kg. Facial angioedema developed for all patients (100%) and generalized urticaria for 38% of challenged patients, irrespective of age. There was no circulatory compromise, but respiratory symptoms of tachypnea, wheezing, and/or cough were documented for 42% of patients. A cross-reactive hypersensitivity response to acetaminophen was documented for 46% of our patients through their history and for 25% through diagnostic challenge. Compared with patients with suspected adverse drug reactions to antibiotics, patients in the NSAID group were older (7.4 vs 4.8 years) and more likely to have a diagnosis of asthma (odds ratio: 7.5; 95% confidence interval: 3.1-19). Conclusions. Early presentations of facial angioedema and urticaria are key features of dose- and potency-dependent, cross-reactive reactions to NSAIDs in a subpopulation of young, Asian, atopic children. Significant overlap with acetaminophen hypersensitivity, especially among very young patients, for whom the use of a cyclooxygenase-2-specific medication may not be feasible, severely limits options for medical antipyretic treatment. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2005-0969; nonsteroidal antiinflammatory drug, children, urticaria, atopy, angioedema.</description><subject>Adverse and side effects</subject><subject>Adverse drug reactions</subject><subject>Angioedema</subject><subject>Angioneurotic edema</subject><subject>Asian people</subject><subject>Children & youth</subject><subject>Complications and side effects</subject><subject>Drug therapy</subject><subject>Drugs</subject><subject>Inflammatory diseases</subject><subject>Nonsteroidal anti-inflammatory agents</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Pediatrics</subject><subject>Risk factors</subject><subject>Side effects</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><recordid>eNotjs1qwzAQhE1poWnadxA9x6BfSz6GkP5AIJfcjSKvHQVZciW5rV-mz1pDe5pd5tvZuSlWBNeq5FSK22KFMSMlx1jcFw8pXTHGXEi6Kn72OroZjRES-KyzDR592XxB2vc2QAuDXsYWTTFbo6PVyHpkYkipjKBNtp-ALvMIcTlPdlltnlEOyAefMsRgW-2WgGyt75weBp1DnFEbpz4hPQTfozlMvt-gbbLab9Dij9Ygc7GujeAfi7tOuwRP_7ouTi_70-6tPBxf33fbQ9lXoi7F-Wy0IkxiSbEiitZAMGMgGJNdB5wTroTAZyKqzkiuNG_rusKEcoUx4RVbF89_sWMMHxOk3FzDFP3ysaFUsZpLWS9Q-Qf12kFjvQk-w3c2wTnooVn67I7NljAlBaGiZr-ZqHd5</recordid><startdate>20051101</startdate><enddate>20051101</enddate><creator>Kidon, Mona Iancovici</creator><creator>Kang, Liew Woei</creator><creator>Chin, Chiang Wen</creator><creator>Hoon, Lim Siok</creator><creator>See, Yvonne</creator><creator>Goh, Anne</creator><creator>Lin, Jenny Tang Poh</creator><creator>Chay, Oh Moh</creator><general>American Academy of Pediatrics</general><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope></search><sort><creationdate>20051101</creationdate><title>Early presentation with angioedema and urticaria in cross-reactive hypersensitivity to nonsteroidal antiinflammatory drugs among young, Asian, atopic children</title><author>Kidon, Mona Iancovici ; Kang, Liew Woei ; Chin, Chiang Wen ; Hoon, Lim Siok ; See, Yvonne ; Goh, Anne ; Lin, Jenny Tang Poh ; Chay, Oh Moh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-g659-5bbca8137072081829e1033e5337ffe44148550b156fc748a4d99601248001463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adverse and side effects</topic><topic>Adverse drug reactions</topic><topic>Angioedema</topic><topic>Angioneurotic edema</topic><topic>Asian people</topic><topic>Children & youth</topic><topic>Complications and side effects</topic><topic>Drug therapy</topic><topic>Drugs</topic><topic>Inflammatory diseases</topic><topic>Nonsteroidal anti-inflammatory agents</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>Pediatrics</topic><topic>Risk factors</topic><topic>Side effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kidon, Mona Iancovici</creatorcontrib><creatorcontrib>Kang, Liew Woei</creatorcontrib><creatorcontrib>Chin, Chiang Wen</creatorcontrib><creatorcontrib>Hoon, Lim Siok</creatorcontrib><creatorcontrib>See, Yvonne</creatorcontrib><creatorcontrib>Goh, Anne</creatorcontrib><creatorcontrib>Lin, Jenny Tang Poh</creatorcontrib><creatorcontrib>Chay, Oh Moh</creatorcontrib><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kidon, Mona Iancovici</au><au>Kang, Liew Woei</au><au>Chin, Chiang Wen</au><au>Hoon, Lim Siok</au><au>See, Yvonne</au><au>Goh, Anne</au><au>Lin, Jenny Tang Poh</au><au>Chay, Oh Moh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early presentation with angioedema and urticaria in cross-reactive hypersensitivity to nonsteroidal antiinflammatory drugs among young, Asian, atopic children</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2005-11-01</date><risdate>2005</risdate><volume>116</volume><issue>5</issue><spage>1208</spage><pages>1208-</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>Objective. Nonsteroidal antiinflammatory drugs (NSAIDs), mainly ibuprofen, are used extensively among children as analgesic and antipyretic agents. Our initial survey in the Kendang Kerbau Children's Hospital in Singapore showed NSAIDs to be the second most common adverse drug reaction-causing medications among children of Asian descent. We attempted to characterize the clinical and epidemiologic profile of NSAID reactions in this group of patients. Methods. A retrospective case series from a hospital-based pediatric drug allergy clinic was studied. A diagnosis of NSAID hypersensitivity was made with a modified oral provocation test. Atopy was evaluated clinically and tested with a standard panel of skin-prick tests. We excluded from analysis patients with any unprovoked episodes of urticaria and/or angioedema, patients <1 year of age, and patients who refused a diagnostic challenge test. Results. Between March 1, 2003, and February 28, 2004, 24 patients, including 14 male patients (58%) and 18 Chinese patients (75%), with a mean age of 7.4 years (range: 1.4-14.4 years), were diagnosed as having cross-reactive NSAID hypersensitivity. A family history consistent with NSAID hypersensitivity was elicited for 17% of patients. None of the patients reported any episodes of angioedema/urticaria unrelated to NSAIDs. The median cumulative reaction-eliciting dose was 7.1 mg/kg. Facial angioedema developed for all patients (100%) and generalized urticaria for 38% of challenged patients, irrespective of age. There was no circulatory compromise, but respiratory symptoms of tachypnea, wheezing, and/or cough were documented for 42% of patients. A cross-reactive hypersensitivity response to acetaminophen was documented for 46% of our patients through their history and for 25% through diagnostic challenge. Compared with patients with suspected adverse drug reactions to antibiotics, patients in the NSAID group were older (7.4 vs 4.8 years) and more likely to have a diagnosis of asthma (odds ratio: 7.5; 95% confidence interval: 3.1-19). Conclusions. Early presentations of facial angioedema and urticaria are key features of dose- and potency-dependent, cross-reactive reactions to NSAIDs in a subpopulation of young, Asian, atopic children. Significant overlap with acetaminophen hypersensitivity, especially among very young patients, for whom the use of a cyclooxygenase-2-specific medication may not be feasible, severely limits options for medical antipyretic treatment. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2005-0969; nonsteroidal antiinflammatory drug, children, urticaria, atopy, angioedema.</abstract><cop>Evanston</cop><pub>American Academy of Pediatrics</pub></addata></record> |
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| subjects | Adverse and side effects Adverse drug reactions Angioedema Angioneurotic edema Asian people Children & youth Complications and side effects Drug therapy Drugs Inflammatory diseases Nonsteroidal anti-inflammatory agents Nonsteroidal anti-inflammatory drugs Pediatrics Risk factors Side effects |
| title | Early presentation with angioedema and urticaria in cross-reactive hypersensitivity to nonsteroidal antiinflammatory drugs among young, Asian, atopic children |
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