D3.53 - A retrospective audit of NSAID hypersensitivity in children and young people in a tertiary paediatric allergy centre

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently reported drugs associated with hypersensitivity reactions in children. Our aim was to evaluate current practice in a tertiary paediatric allergy unit in the management of NSAID hypersensitivity with respect to NICE guidance (CG183). 

We conducted a retrospective review of patient records over a 10-year period (2014-24) to identify children presenting with suspected NSAID hypersensitivity. Data collected included symptoms of the reactions to the NSAID, results of investigations (skin prick or specific IgE blood testing), outcomes of NSAID challenges, past medical history of atopy, and paracetamol tolerance. 

We identified 116 individuals presenting to our unit within the 10-year period, with a mean age of 4 years 3 months. Of these 50 % were female and in the vast majority (96; 83%) ibuprofen was the drug implicated. Most individuals presented with either angioedema (60; 52%), urticaria (19; 16%) or a non-urticarial rash (48; 41%). Just over one third (39%) had an atopic predisposition. All these children had a clinical letter documenting the signs and symptoms of their clinical reactions and initial advice on NSAID avoidance. Two individuals presented with symptoms suggestive of anaphylaxis, however neither had a serum tryptase taken acutely. Of the 116 children, 62 underwent skin prick testing of which 3 were positive, and 44 underwent specific IgE testing, of which 1 was positive. Following testing, 80 had a challenge undertaken to a NSAID, either to confirm or refute the diagnosis, or to identify whether such children reacted to an alternative NSAID. Five children reacted to the NSAID on challenge (2 reacted to ibuprofen, 2 to paracetamol and 1 to both ibuprofen and diclofenac). Two of these reactions were immediate, occurring within 2 hours of drug ingestion, the rest were delayed symptoms (angioedema, rashes, swallowing difficulty). Four of these 5 children were atopic (eczema, hay fever and/or asthma). Once testing had taken place, 95% of the individuals had documented advice on information and support including which NSAIDs if any were safe to take. There was no documentation of nasal polyposis in any of our individuals.

Our results demonstrate that we generally adhered well to NICE guidelines in NSAID hypersensitivity management but improvements with respect to documentation are required.