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Anaphylaxis to diclofenac: nine cases reported to the Allergy Vigilance Network in France
Author(s) -
Picaud J.,
Beaudouin E.,
Renaudin J. M.,
Pirson F.,
MetzFavre C.,
DronGonzalvez M.,
MoneretVautrin D. A.
Publication year - 2014
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.12458
Subject(s) - anaphylaxis , allergy , medicine , vigilance (psychology) , diclofenac , immunology , anesthesia , psychology , neuroscience
Nine cases of diclofenac hypersensitivity recorded by the Allergy Vigilance Network in France from 2002 to 2012 were studied. Data from history, symptoms, skin tests, basophil activation tests, and oral challenge ( OC ) were recorded. Grade 3 severe anaphylactic reactions occurred in seven cases of nine. IgE‐dependent anaphylaxis was confirmed in six cases: positive intradermal tests ( n = 4), a syndromic reaction during skin tests ( n = 1), and one case with grade 1 reaction and negative skin tests had an anaphylactic shock to the OC . A nonimmune reaction was suspected in one case. An IgE‐dependent mechanism may be the predominant cause of adverse reactions to diclofenac. Allergy skin tests must be carried out sequentially at the recommended concentrations. BAT s may be helpful because they can support the diagnosis of anaphylaxis. Given the risks of a direct challenge to diclofenac, OC to aspirin should be performed first to exclude a nonimmunologic hypersensitivity to NSAID s. Tests for specific IgEs to most frequently used NSAID s such as diclofenac and ibuprofen are urgently needed.