D2.398 - Ibuprofen Challenge or Desensitisation in Myo-Pericardial Disease: A Case Series

Desensitisation to non-steroidal anti-inflammatory drugs (NSAIDs) is well established for acetylsalicylic acid, particularly in patients requiring antiplatelet therapy or with aspirin-exacerbated respiratory disease. In contrast, desensitisation to other COX-1–inhibiting NSAIDs at anti-inflammatory doses is rarely reported and is generally not required for cardiological indications. However, current cardiology guidelines recommend high-dose NSAID therapy as first-line treatment for acute and recurrent pericarditis and myopericarditis, with ibuprofen often preferred due to its favourable gastrointestinal tolerability and flexible dosing.Objective:to describe a case series of NSAID-hypersensitive patients who successfully underwent ibuprofen challenge or desensitisation at anti-inflammatory doses for the treatment of myo-pericardial diseases.

We retrospectively analysed five patients with documented NSAID hypersensitivity who required ibuprofen for acute, recurrent, chronic, or resolving pericarditis or myopericarditis. Based on individual clinical history and reaction phenotype, patients underwent either a graded desensitisation protocol or a controlled drug challenge. All procedures were performed under specialist supervision. Antihistamine premedication was administered in all cases, with leukotriene receptor antagonists added when appropriate. Clinical tolerance and cardiological outcomes were assessed.

All patients successfully reached the target therapeutic dose of ibuprofen (600–1200 mg/day). No severe hypersensitivity reactions occurred, and none required protocol interruption or treatment discontinuation. The cohort included patients with multiple NSAID intolerance, NSAID-induced urticaria/angioedema, NSAID-exacerbated chronic urticaria (NECD), and mild respiratory symptoms. All patients completed the prescribed cardiological therapy and showed clinical improvement or disease resolution during follow-up.

Ibuprofen challenge or desensitisation at anti-inflammatory doses appears to be a feasible and safe strategy in carefully selected NSAID-hypersensitive patients with pericardial disease. Premedication with antihistamines, and in selected cases leukotriene receptor antagonists, may facilitate tolerance. Compared with aspirin, ibuprofen may offer advantages in short-term cardiological settings due to a lower risk of gastrointestinal adverse effects, allowing adherence to guideline-recommended therapy without compromising safety.