Diagnostic Value of Oral Provocation Tests in Drug Hypersensitivity Reactions Induced by Nonsteroidal Anti-Inflammatory Drugs and Paracetamol
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Group
2.2. Diagnostic Tests
2.3. Follow-Up
2.4. Identification of Excipients in Generic Drugs of Interest
2.5. Statistical Analysis
3. Results
3.1. General Characteristic of the Study Group
3.2. Patients with False Negative Drug Provocation Tests (Group A2)
3.3. Patients Who Avoided Reexposure (Group B)
3.4. Excipients in Medicinal Products of Interest and Their Potential for Inducing Hypersensitivity Reactions
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient’s Code | Suspected Drug | Phenotype of Initial Reaction | Tested Drug | Reaction Developed after Reexposure |
---|---|---|---|---|
18 | NSAID | NIUA | ASA | angioedema (face, larynx) |
124 | NSAID | NIUA | urticaria | |
96 | ASA | SNIUAA | urticaria | |
106 | ASA | SNIUAA | urticaria and erythema | |
78 | IBU | SNIUAA | angioedema (lips and eyelids) | |
9 | PRC | SNIUAA | urticaria | |
47 | NAP | SNIUAA | urticaria | |
68 | KET | SNIUAA | urticaria | |
104 | KET | NERD | dyspnoea | |
128 | PRC | NERD | PRC | erythema |
22 | NSAID | NIUA | MEL | rush |
70 | DIC | SNIUAA | DIC | rush |
Group A2 (Positive Reexposure) | Group A1 (Negative Reexposure) | p-Value | |
---|---|---|---|
age (y) | 55.8 ± 11.1 | 52.2 ± 1.6 | ns |
time span to interview (m) | 36.5 ± 19.7 | 32.8 ± 18.0 | ns |
sex: F/M (n) | 5/7 | 98/21 | 0.001 |
NIUA (%) | 25% | 58% | ns |
SNIUAA (%) | 58% | 40% | ns |
NERD (%) | 17% | 2% | ns |
any positive SPT for seasonal allergens (%) | 14% | 25% | ns |
any positive SPT for perennial allergens (%) | 43% | 27% | ns |
Group A (n = 131) The Reexposure Took Place | Group B (n = 33) No Reexposure Took Place | p-Value | |
---|---|---|---|
age (y) | 52.5 ± 16.2 | 54.2 ± 15.8 | ns |
time span to interview (m) | 33.1 ± 18.1 | 30.9 ± 17.9 | ns |
sex: F/M (n) | 103/28 | 27/6 | ns |
NIUA (%) | 54% | 52% | ns |
SNIUAA (%) | 42% | 45% | ns |
NERD (%) | 4% | 3% | ns |
any positive SPT for seasonal allergens (%) | 24% | 9% | ns |
any positive SPT for perennial allergens (%) | 29% | 25% | ns |
Substance | Number of Records | Hypersensitivity Reaction or Immune-Mediate Response to a Given Substance | References |
---|---|---|---|
Acesulfame potassium | 2 | hives and discomfort in the throat, swelling of the lips and face, sinus congestion, and difficulty breathing | [31] |
Alpha-tocopherol | 5 | contact dermatitis | [32] |
Aspartame | 5 | urticaria | [33] |
Carmine | 30 | anaphylaxis, dye-induced immediate allergy | [34,35] |
Calcium phosphate | 4 | positive patch test, contact dermatitis | [36] |
Cetyl alcohol | 5 | contact dermatitis | [37] |
Citric acid | 7 | anaphylaxis | [38] |
Cochineal red | 2 | anaphylaxis | [39] |
Colloidal silica | 1 | skin hypersensitivity | [40] |
Corn starch | 1 | cell-mediated immunity | [41] |
Croscarmellose sodium | 1 | erythematous skin rash with diffuse itching | [42] |
Dimethicone | 1 | contact dermatitis | [43] |
Glycine | 18 | anaphylaxis | [44] |
Gelatine | 6 | anaphylaxis | [45] |
Hydrogenated castor oil | 1 | contact dermatitis | [46] |
Hydroxypropyl cellulose | 1 | cross-reactivity to propylene glycol, contact dermatitis | [47] |
Hypromellose | 3 | contact dermatitis, anaphylaxis | [48,49] |
Macrogol | 14 | anaphylaxis | [50] |
Maltodextrin | 1 | sterile peritonitis, delayed reaction | [51] |
Mannitol | 19 | anaphylaxis | [52,53,54,55] |
Polysorbate 80 | 19 | anaphylaxis, urticaria | [56,57] |
Polyvinylpyrrolidone | 6 | anaphylaxis | [58,59] |
Povidone | 41 | anaphylaxis | [60,61,62] |
Potato starch | 1 | anaphylaxis | [63] |
Propylene glycol | 20 | immediate drug hypersensitivity reactions | [64] |
Quinoline yellow | 3 | fixed food and drug-induced eruption | [65] |
Sodium benzoate | 2 | pruritus, fixed drug eruption | [66,67] |
Sorbic acid | 2 | generalized contact urticaria | [68] |
Sorbitol | 7 | allergic contact dermatitis | [69] |
Starch | 28 | anaphylaxis | [70] |
Stearic acid | 5 | cosmetic allergy from stearic acid and glyceryl stearate | [71] |
Sunset yellow | 3 | oro-facial granulomatosis, eczema | [72,73] |
Titanium dioxide | 7 | allergic contact dermatitis | [74] |
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Popiolek, I.; Blasiak, M.; Kozak, A.; Pietak, E.; Bulanda, M.; Porebski, G. Diagnostic Value of Oral Provocation Tests in Drug Hypersensitivity Reactions Induced by Nonsteroidal Anti-Inflammatory Drugs and Paracetamol. Diagnostics 2022, 12, 3074. https://doi.org/10.3390/diagnostics12123074
Popiolek I, Blasiak M, Kozak A, Pietak E, Bulanda M, Porebski G. Diagnostic Value of Oral Provocation Tests in Drug Hypersensitivity Reactions Induced by Nonsteroidal Anti-Inflammatory Drugs and Paracetamol. Diagnostics. 2022; 12(12):3074. https://doi.org/10.3390/diagnostics12123074
Chicago/Turabian StylePopiolek, Iwona, Magdalena Blasiak, Aleksandra Kozak, Ewelina Pietak, Malgorzata Bulanda, and Grzegorz Porebski. 2022. "Diagnostic Value of Oral Provocation Tests in Drug Hypersensitivity Reactions Induced by Nonsteroidal Anti-Inflammatory Drugs and Paracetamol" Diagnostics 12, no. 12: 3074. https://doi.org/10.3390/diagnostics12123074
APA StylePopiolek, I., Blasiak, M., Kozak, A., Pietak, E., Bulanda, M., & Porebski, G. (2022). Diagnostic Value of Oral Provocation Tests in Drug Hypersensitivity Reactions Induced by Nonsteroidal Anti-Inflammatory Drugs and Paracetamol. Diagnostics, 12(12), 3074. https://doi.org/10.3390/diagnostics12123074