Farmacoriflessioni
Ipersensibilità ai FANS: intolleranza o allergia?
NSAIDs hypersensitivity: intolerance or allergy?
Laura Levantino1, Cristiana Corrado1, Laura Badina2, Sara Lega2, Egidio Barbi1,2
1Università di Trieste
2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Gennaio 2021 - pagg. 37 -43 | DOI: 10.53126/MEB40037
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are the main triggers of drug hypersensitivity reactions in children. According to the EAACI latest classification NSAIDs hypersensitivity reactions are differentiated into cross-reactive reactions, with non-immunological mechanisms (based on COX-1 inhibition), and selective reactions, with immunological mechanisms. Paediatric clinical manifestations of NSAID hypersensitivity are typically cutaneous, but sometimes, similarly to anaphylaxis, can involve other systems, especially the respiratory one. Differentiating between NSAID intolerance and NSAID allergy through drug provocation tests is crucial for the patient because the two clinical entities require different management.
Riassunto
I farmaci antinfiammatori non steroidei (FANS) sono i principali fattori scatenanti delle reazioni di ipersensibilità ai farmaci nei bambini. Secondo l'ultima classificazione EAACI le reazioni di ipersensibilità ai FANS sono differenziate in reazioni cross-reattive, con meccanismi non immunologici (basati sull'inibizione della COX-1), e reazioni selettive, con meccanismi immunologici. Le manifestazioni cliniche pediatriche di ipersensibilità ai FANS sono tipicamente cutanee, ma talvolta possono coinvolgere, analogamente all'anafilassi, altri apparati, soprattutto quello respiratorio. La differenziazione tra intolleranza ai FANS e allergia ai FANS attraverso i test di provocazione farmacologica è fondamentale per il paziente perché le due entità cliniche richiedono una gestione diversa.
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Wohrl S. NSAID hypersensitivity - recommandations for diagnostic work up and patient management. Allergo J Int 2018;27:114-21. DOI: 10.1007/s40629-018-0064-0.
2. Huang SH. Rheumatology: 7. Basics of therapy. CMAJ 2000;163:417-23.
3. Cantley L. La trasduzione del segnale. In: Boron WF, Boulpaep EL. Fisiologia medica - 3ed. Edra SpA 2018:48-74.
4. Kowalski ML, Asero R, Bavbek S, et al. Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy 2013;68:1219-32. DOI: 10.1111/all. 12260.
5. Blanca M, Doña I, Torres M, et al. Non Steroids Anti-inflammatory Drugs (NSAIDs) intolerance versus allergy: patterns of response and drug involved. J Allergy Clin Immunol 2009;123:S239. DOI: 10.1016/j.jaci. 2008.12.921.
6. Blanca-López N, Haroun-Diaz E, Ruano FJ, Pérez-Alzate D, Somoza ML, Vázquez de la Torre Gaspar M. Acetyl salicylic acid challenge in children with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs differentiates between cross-intolerant and selective responders. J Allergy Clin Immunol Pract 2018;6:1226-35. DOI: 10.1016/j.jaip. 2017.08.029.
7. Gomes ER, Brockow K, Kuyucu S. Drug hypersensitivity in children: report from the pediatric task force of the EAACI Drug Allergy Interest Group. Allergy 2016;61:149-61. DOI: 10.1111/all.12774.
8. Doña I, Pérez-Sánchez N, Eguiluz-Gracia I, et al. Progress in understanding hupersensitivity reactions to nonsteroidal anti-inflammatory drugs. Allergy 2020;75:561-75. DOI: 10.1111/all.14032.
9. Stevenson DD, Sanchez-Borges M, Szczeklik A. Classification of allergic and pseudoallergic reactions to drug that inhibit cyclooxygenase enzyme. Ann Allergy Asthma Immunol 2001;87:177-80. DOI: 10.1016/ S1081-1206(10)62221-1.
10. Kidon M, Blanca-Lopez N, Gomes E, et al. EAACI/ENDA Position Paper: diagnosis and management of hypersesitivity reactions to non-steroidal anti-inflammatory drug (NSAID) in children and adolescents. Pediatr Allergy Immunol 2018;29:469-80. DOI: 10.1111/pai.12915.
11. Sanchez-Borges M, Iancovici Kidon M. Reactions to nonsteroidal anti-inflammatory drugs in children. J Allergy Clin Immunol Pract 2018;6:1236-7. DOI: 10.1016/j.jaip.2017.09.027.
12. Topal OZ, Celik IK, Yagmur IT. Results of NSAID provocation test and difficulties of the classification of NSAID hypersensitivity diagnosed children. Ann Allergy Asthma Immunol 2020;125:202-7. DOI: 10.1016/j.anai.2020. 04.003.
13. Cousin M, Chiriac A, Molinari N, Demoly P, Caimmi D. Phenotypical characterization of children with hypersensitivity reactions to NSAIDs. Pediatr Allergy Immunol 2016;7:743-8. DOI: 10.1111/pai.12596.
14. Topal E, Celiksoy MH, Catal F, Sayan YG, Sancak R. The value of the clinical history for the diagnosis of immediate non-steroidal anti-inflammatory drug hypersensistivity and safe alternative drugs in children. Allergy Asthma Proc 2016;37:57-63. DOI: 10.2500/aap.2016.37.3917.
15. Doña I, Barrionuevo E, Salas M, et al. Natural evolution in patients with nonsteroidal anti-inflammatory drug-induced urticaria/angioedema. Allergy 2017;72:1346-55. DOI: 10.1111/all.13147.
16. Rojas-Pérez-Ezquerra P, Sánchez-Morillas L, Gómez-Traseira C, Gonzalez-Mendiola R, Alcorta Valle AR, Laguna-Martinez J. Selective hypersensitivity reactions to acetaminophen: a 13-case series. J Allergy Clin Immunol Pract 2014;2:343-5. DOI: 10.1016/j. jaip.2013.12.004.
Corrispondenza: laura.levantino88@libero.it