BACKGROUND:In up to 70%-80% of patients with a suspected non-steroidal anti-inflammatory drug hypersensitivity (NSAIDH), challenge tests with the culprit drug yield negative results. On the other hand, there could be a NSAIDH overdiagnosis when anaphylaxis is the clinical manifestation. We hypothesize that some negative NSAID challenge tests and an overdiagnosis of NSAIDH occur in patients with food-dependent NSAID-induced hypersensitivity (FDNIH). METHODS:We studied 328 patients with a suspected acute NSAIDH. FDNIH was diagnosed in patients meeting all the following: (1) tolerance to the food ingested more temporally closed before the reaction, later the episode, (2) respiratory or cutaneous symptoms or anaphylaxis related to NSAID, (3) positive skin prick test to foods and/or specific IgE to food allergens (Pru p 3, Tri a 19, Pen a 1) involved in the reaction, and (4) negative oral provocation test to the culprit NSAID. RESULTS:199 patients (60%) were diagnosed with NSAIDH and 52 (16%) with FDNIH. Pru p 3 was involved in 44 cases (84.6%) and Tri a 19 in 6 cases (11%). FDNIH subjects were younger (p < .001), with a higher prevalence of rhinitis (p < .001) and previous food allergy (p < .001), together with a higher proportion of subjects sensitized to pollens (p < .001) and foods (p < .001). Using just four variables (Pru p 3 sensitization, Tri a 19 sensitization, anaphylaxis, and any NSAID different from pyrazolones), 95.3% of cases were correctly classified, with a sensitivity of 92% and specificity of 96%. CONCLUSION:Evaluation of FDNIH should be included in the diagnostic workup of NSAIDH.

译文

背景:在高达70%-80%的怀疑患有非甾体类抗炎药超敏反应(NSAIDH)的患者中,使用该罪魁祸首药物进行的激发试验得出阴性结果。另一方面,当过敏反应为临床表现时,可能存在NSAIDH过度诊断。我们假设在食物依赖性NSAID引起的超敏反应(FDNIH)患者中发生了一些阴性的NSAID挑战试验和NSAIDH的过度诊断。
方法:我们研究了328例疑似急性NSAIDH的患者。在满足以下所有条件的患者中诊断出FDNIH:(1)对反应前,后发作更短暂地进食的食物具有耐受性,(2)与NSAID相关的呼吸或皮肤症状或过敏反应,(3)皮肤点刺试验阳性食物和/或与反应有关的食物过敏原的特定IgE(Pru p 3,Tri a 19,Pen a 1),以及(4)对罪魁祸首NSAID的口服刺激试验为阴性。
结果:199例患者(60%)被确诊为NSAIDH,52例(16%)被诊断为FDNIH。 Pru p 3涉及44例(84.6%),Tri a 19涉及6例(11%)。 FDNIH受试者年龄较小(p <.001),鼻炎患病率较高(p <.001),既往食物过敏(p <.001)以及对花粉敏感的受试者比例较高(p <.001)和食物(p <.001)。仅使用四个变量(Pru p 3致敏,Tri a 19致敏,过敏反应以及与吡唑啉酮不同的任何NSAID),正确分类了95.3%的病例,敏感性为92%,特异性为96%。
结论:FDAIH的评估应包括在NSAIDH的诊断检查中。

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