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Food‐dependent NSAID‐induced hypersensitivity (FDNIH) reactions: Unraveling the clinical features and risk factors
Author(s) -
SánchezLópez Jaime,
Araujo Giovanna,
Cardona Victoria,
GarcíaMoral Alba,
CasasSaucedo Rocío,
Guilarte Mar,
Torres María José,
Doña Inmaculada,
Picado Cesar,
Pascal Mariona,
MuñozCano Rosa,
Bartra Joan
Publication year - 2021
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.14689
Subject(s) - medicine , culprit , overdiagnosis , sensitization , provocation test , anaphylaxis , allergy , food allergy , gastroenterology , immunoglobulin e , drug allergy , dermatology , oral allergy syndrome , immunology , antibody , pathology , alternative medicine , myocardial infarction
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.