@article {Zisa:2012:1088-5412:421,
title = "Provocation tests with the offending nonsteroidal anti-inflammatory drugs in patients with urticaria/angioedema reactions",
journal = "Allergy and Asthma Proceedings",
parent_itemid = "infobike://ocean/aap",
publishercode ="ocean",
year = "2012",
volume = "33",
number = "5",
publication date ="2012-09-01T00:00:00",
pages = "421-426",
itemtype = "ARTICLE",
issn = "1088-5412",
eissn = "1539-6304",
url = "https://www.ingentaconnect.com/content/ocean/aap/2012/00000033/00000005/art00007",
doi = "doi:10.2500/aap.2012.33.3590",
keyword = "nonsteroidal anti-inflammatory drugs, urticaria, Angioedema, cutaneous reaction, COX-1 inhibitors, diagnosis, provocation tests, COX-2 inhibitors, drug hypersensitivity, atopy, cross-reactivity",
author = "Zisa, Giuliana and Riccobono, Francesca and Bommarito, Luisa and D'Antonio, Cristian and Calamari, Ambra Marianna and Poppa, Mariangela and Moschella, Maria Adele and Di Pietrantonj, Carlo and Galimberti, Maurizio",
abstract = "The provocation test (PT) with the suspected drug represents the gold standard in the diagnosis of non-IgE hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). Nevertheless, there is no consensus regarding the clinical management of suspected NSAID-sensitive
patients. This study assessed if a PT with the suspected drug is a reliable and safe proceeding to confirm NSAID hypersensitivity in patients with a clinical history of urticaria/angioedema (Urt/AE). It also analyzed different patient characteristics (such as gender, age, atopy, dermographism,
time interval between the last drug reaction, and number of previous NSAID reactions) in relation to PT positivity. One hundred fifty-nine patients with Urt/AE apparently related to assumption of one or more NSAIDs underwent PT with the suspected drugs. Moreover, to distinguish single/multiple
NSAID reactivity in patients who did not tolerate the offending NSAID, another strong cyclooxygenase-1 inhibitor PT was performed. PT was negative in 142/159 patients (89.31%), ruling out a diagnosis of NSAIDs hypersensitivity; 17/159 patients (10.69%) experienced a reaction of Urt/AE during
the PT: 8 patients were diagnosed as single reactors to NSAIDs and 4 as multiple reactors to NSAIDs. Those with a history of multiple NSAID reactions and male patients were both more likely to have a positive PT. Our results suggest that in all patients with history of NSAID cutaneous reactions,
the NSAID hypersensitivity should be confirmed by an oral PT and that the diagnostic proceeding can safely start with the offending NSAID.",
}