背景:非甾体抗炎药(NSAIDs)在儿科年龄组中经常用作止痛药,退烧药和抗炎药。由于NSAIDs在许多医疗条件下使用,有必要在有超敏反应的患者中安全使用替代性NSAIDs.选择性和部分选择性COX-2抑制剂和弱COX-1抑制剂通常用作安全的替代药物。这项研究的目的是根据NSAID超敏反应儿童的表型评估通过口服激发试验(OPT)确定的安全NSAID。
方法:使用替代性NSAIDs(扑热息痛,美洛昔康,尼美舒利,对2015年1月至2023年2月在儿科免疫学和过敏科随访诊断为NSAID超敏反应的患者进行了回顾性评估。
结果:在研究期间,91例患者接受了109种替代药物的OPT,其中48(52.7%)是女孩,平均年龄为15岁。91例患者对117种药物有反应史。作为替代NSAID;58例患者使用扑热息痛进行OPT,美洛昔康治疗44例患者,尼美舒利在5例患者中,和塞来昔布2例。由于15名患者在家中安全使用扑热息痛,对乙酰氨基酚未进行试验.在73例接受对乙酰氨基酚OPT的患者中,有3例(4.1%)和44例接受美洛昔康OPT的患者中,有2例(4.5%)发生了反应。在后2例患者中也观察到对尼美舒利的反应(2/5,40%),但他们似乎容忍塞来昔布.在接受塞来昔布测试的2例患者中未观察到反应。
结论:扑热息痛,美洛昔康,尼美舒利可作为大多数NSAID超敏反应儿童的安全替代药物。选择性COX-2抑制剂应作为不能耐受的患者的替代药物。
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used in the pediatric age group as pain relievers, antipyretics and anti-inflammatory drugs. Since NSAIDs are used in many medical conditions, there is a need for alternative NSAIDs to be used safely in people with hypersensitivity reactions. Selective and partially selective COX-2 inhibitors and weak COX-1 inhibitors are generally used as safe alternative drugs. The aim of this study was to evaluate safe NSAIDs determined by oral provocation tests (OPTs) according to phenotypes in children with NSAID hypersensitivity reactions.
METHODS: The results of the oral provocation test performed with alternative NSAIDs (
paracetamol, meloxicam, nimesulide, celecoxib) in patients followed up with the diagnosis of NSAID hypersensitivity reaction in the Pediatric Immunology and Allergy Department between January 2015 and February 2023 were evaluated retrospectively.
RESULTS: During the study period, 91 patients underwent OPTs with 109 alternative drugs 48 (52.7%) of whom were girls, with a median age of 15 years. 91 patients had a history of reactions to 117 drugs. As an alternative NSAID; OPT was performed with
paracetamol in 58 patients, meloxicam in 44 patients, nimesulide in 5 patients, and celecoxib in 2 patients. Since 15 patients used
paracetamol safely at home, no tests were performed with
paracetamol. Reactions were observed in 3 of the 73 patients (4.1%) who underwent OPT with
paracetamol and in 2 of the 44 (4.5%) who underwent OPT with meloxicam. Reactions to nimesulide were also observed in the latter 2 patients (2/5, 40%), but they appeared to tolerate celecoxib. No reaction was observed in the 2 patients who were tested with celecoxib.
CONCLUSIONS: Paracetamol, meloxicam, and nimesulide can be used as safe alternative drugs in most children with NSAID hypersensitivity. Selective COX-2 inhibitors should be tried as an alternative in patients who cannot tolerate them.