TITLE:
Oral Provocation Test in Non-Steroidal Anti-Inflammatory Drug Hypersensitive Patients Referred to Singapore General Hospital
AUTHORS:
Chaw Su Naing, Yong Yeow Chong
KEYWORDS:
Non-Steroidal, Anti-Inflammatory Drugs, Hypersensitivity, Cyclooxygenase 2
JOURNAL NAME:
Open Access Library Journal,
Vol.4 No.3,
March
28,
2017
ABSTRACT: Introduction: Non-steroidal anti-inflammatory drugs
(NSAIDs) are frequently prescribed classes
of drugs and are easily accessible as over-the-counter anti-inflammatory drugs in Singapore. NSAIDs hypersensitivity
is the second most common referral to allergy clinic in a tertiary referral
centre. Methods: Referred patients with history of NSAID intolerance were underwent
open challenge with 1) putative NSAID to confirm the diagnosis; 2) Aspirin to
determine the cross-reactivity or 3) selective cyclooxygenase-2 (COX-2)
inhibitor to identify the suitable alternative. Data were analysed
retrospectively. Results: Over a 4-year period (2010-2014), a total of 127
patients (mean age SD 40.7 /- 15.2) underwent a total of
155 open-labelled labelled NSAIDs oral provocation tests (OPT). Overall
positive challenge rate is 26.5% (41 out of 155). Despite having a clinical relevant
history of causative, only 29.4% (20 out of 68) had positive OPT to putative
NSAIDs. Using selective COX-2 inhibitor challenge for assessing the
tolerability of suitable alternative, we found only 8.8% (5 out of 57) positive
challenge. Conclusions: In our 4-year patients cohort with history of NSAIDs of
intolerance, positive OPT rate of 26.5% in confirming diagnosis of NSAIDs
hypersensitivity. The intolerance to selective COX-2 inhibitor was found in
8.8% of patients with non-steroidal anti-inflammatory drugs hypersensitivity
patients.