D2.287 - Evaluation of NSAID Hypersensitivity in Children: A Retrospective Analysis

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common causes of drug hypersensitivity reactions in children, second only to antibiotics. This study aims to evaluate NSAID-associated hypersensitivity reactions in pediatric patients.

Children (<18 years old) who presented with a history of NSAID hypersensitivity (NSAID-H) at the Pediatric Immunology and Allergy Clinic of Ankara Training and Research Hospital between January 1, 2017, and June 1, 2024, were included in the study. The patients’ presenting complaints, demographic data, laboratory and diagnostic test results, and final diagnoses were retrospectively analyzed from patient records.

A total of 145 NSAID-related hypersensitivity reactions were analyzed in 117 patients (28 patients experienced reactions to multiple drugs at the time of presentation). The median age at the time of reaction was 6 years (IQR: 3.5-12), while the median age at the time of testing was 8 years (IQR: 4-12), and 53% of the patients were male. The presence of concomitant allergic diseases was identified in 39.3% of patients (allergic rhinitis: 17.9%, chronic urticaria: 14.5%, asthma: 9.4%), and 31.6% of patients had a family history of allergic disease. The most frequently implicated drugs were ibuprofen (n=66, 45.5%) and paracetamol (n=56, 38.6%). The majority of reactions (57.9%) were delayed (>6 hours), while 25.5% were immediate. The most common clinical symptoms were cutaneous manifestations (97.9%), including angioedema (50.3%), erythema (43.3%), and urticaria (9.7%), while 7.5% of patients had a history of anaphylaxis. Diagnostic testing ruled out NSAID-H in 82.9% of patients. Among patients with confirmed NSAID-H, all had a history of angioedema, and 46.6% had a history of anaphylaxis. In 29 patients who continued diagnostic evaluations, oral provocation tests (OPT) were conducted to identify alternative drugs, including paracetamol, ibuprofen, and meloxicam.

NSAIDs are one of the most common drug groups responsible for hypersensitivity reactions in children, and confirming these reactions with diagnostic tests is crucial. In this study, NSAID hypersensitivity was ruled out in 82.9% of 88 patients who completed diagnostic testing. Once all patients have undergone complete diagnostic evaluation, further classification will be performed. The preliminary results of our study are presented here.