1174 Assessment of ORAL drug provocation test in the diagnosis of NON-steroidal ANTI-inflammatory drugs hypersensitivity

Wednesday, 14 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)

Bui VAN Khanh, MD , The Center of Allergy and Clinical Immunology, BACH MAI Hospital, HA NOI, Vietnam

Hieu Chi Chu, MD , The Center of Allergy and Clinical Immunology, BACH MAI Hospital, HA NOI, Vietnam

Nguyen Nhu Nguyet, MD , Allergy and Clinical Immunology, Hanoi Medical University, HA NOI, Vietnam

Nguyen Hoang Phuong, MD , The Center of Allergy and Clinical Immunology, BACH MAI Hospital, HA NOI, Vietnam

Background: Hypersensitivity to aspirin and other Non-steroidal anti-inflammatory drugs (NSAIDs) is the second most frequent allergic reaction to drug, which include immunological and nonimmunological with airway and/or skin manifestations. Provocation test is the “gold standard” to diagnose NSAIDs hypersensitivity. Although some of the NSAIDs are reported to be safe for NSAID-intolerant patients, they should not be suggested before confirming the safety by single-blind oral drug provocation tests.

Objective: To assess the role of oral drug provocation test in the diagnosis of NSAIDs hypersensitivity and find out the safe alternative drugs.

Method: Provocation tests with four types of NSAIDs (aspirine - A, ibuprofene - I, meloxicam - M, etoricoxib - E) were administered in patients suspected to be intolerant to NSAIDs by specialists in the Centre of Allergy and Clinical Immunology in Bach Mai hospital.

Results: A total of 156 patients having history suspected of being allergic to NSAIDs (F/M: 81/75: 51,9%/48,1%, mean age: 34,9 ± 14,2 years) were enrolled between May 2012 and April 2015. 624 oral provocation tests with NSAIDs were performed and 299 of them were positive. 142/156 patients (91%) had positive tests, 24 (16,9%) of them were positive for one drug (A: 11 patients, I: 7 patients, M: 5 patients, E: 1 patients) and 83,1% with two or more drugs. Prevalence of A, I, M and E hypersensitivity were 90,8%, 88%, 9,2% and 0,7%; respectively. The average dose (mg) for positive result of A, I, M, E was 60,9±37,6, 118,4±43,4, 6,9±1,1, 30; respectively. The average response time (minutes) from the last dose of A, I, M, E was 63,4±24,1, 69,3±23,4, 78,1±18,7, 120; respectively. Prevalence of cross-reactivity with A of I, M, E was 91,5%, 6,2%, 0%.  The main clinical manifestation as positive test was combined allergic rhinitis and urticaria angioedema (42,5%), only one patient had bronchospasm and no patient had anaphylaxis.

Conclusion: This research showed oral provocation test is a safe test and also a “gold standard” for NSAIDs hypersensitivoty diagnosis. Choosing altenative NSAIDs should base on single-blind provocation tests.