The factors that predict the non- steroidal anti inflammatory DRUG hypersensitivity in children

NSAIDs are one of the most common cause of drug related hypersensitivity reactions. The diagnosis of hypersensitivity to NSAID that based on clinical history is generally misleading. Therefore, in necessary situations skin tests and/or oral provocation tests (OPT) should be performed. The study population was chosen from patients who applied to Department of Allergy and Immunology, Inonu University Hospital in the April 2013 to March 2015 with history of Type 1 (immediate) hypersensitivity to NSAID (NSAID-H). In total 50 patients were included. Of these 50 patients, 22 (44%) were males, 28 (56%) were females, a mean age of 6 (range 1 to 16). 13 (26%) patients described having type 1 NSAID-H reactions in the past. 8 (16%) patients described having these reactions to more than one type of type 1 NSAIDs. 7 (14%) patients had asthma, 7 (14%) patients had allergic rhinitis and 8 (16%) patients had food allergy. 50 % of type 1 NSAID-H reactions had occured in the first hour of medication. 28 of the patients underwent skin prick/intradermal tests. NSAID-H was proven in 13 of 50 (2 of them according to intradermal tests, 11 of them according to OPT). Patients were stratified into 2 groups: those with confirmed NSAID-H and those without NSAID-H. When a one way analysis is used to compare between these two groups the OPT positivie group had more risk factors such as being older than 6 years of age (p=0,006), a positive family history (p=0,039), having a clinical history of hypersensitivity to more than one type of type 1 NSAID (p=0,001), the onset of allergic reaction in the first hour of medication (p=0,004). When logistic regression analysis is used to determine unrelated predictive factors of NSAID-H from clinical history, the onset of allergic reactionin the first hour of medication (OR:22,81 %95 CL 1,520-342,457, P=0,024) and the type 1 hypersenstivity to multiple NSAID drugs (OR:22,85 %95 CL 1,337-390,554 p=0,031) were predictive factors of true NSAID-H. The definitive diagnosis should not be made based on clinical history, when required skin tests and OPTs must be performed. Skin tests and/or OPT must be done to vi establish a firm diagnosis. The history of hypersensitivity to multiple NSAID drugs and the onset of allergic reaction in the first hour of medication are predictive factors of true NSAID-H.