Results of NSAID provocation tests and difficulties of the classification of NSAID hypersensitivity diagnosed children.

Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in children and can frequently cause hypersensitivity reactions. Rates of confirmed NSAID hypersensitivity (NSAID-H) in children are low. Objective The aim of this study was to evaluate the results of drug provocation tests with NSAID and to evaluate the difficulties encountered in the classification of NSAID-H in children. Methods: The study included patients with suspected NSAID-H who were evaluated in our clinic between January 1,2015 and December 31,2018. Oral provocation tests (OPT) with NSAIDs were performed and reactions were classified according to the European Academy of Allergy and Clinical Immunology position paper on NSAID-H. Results A total of 243 patients (57.2% male) presented with suspected NSAID-H during the study period. Most of the patients (n=168, 69.1%) had a history of reaction to ibuprofen. Isolated skin involvement was the most frequent symptom (86%). A total of 238 DPTs were performed with the suspected agents and 34 had positive results. Twelve patients’ families refused provocation testing with the suspected agent or aspirin and these patients couldn’be diagnosed. NSAID-H was diagnosed in a total of 47 (20.3%) of the 231 patients. Twenty patients with NSAID hypersensitivity could not be classified because their guardians did not consent to further testing with aspirin. Conclusion: Performing diagnostic tests is important in patients with no contraindications. Characterizing these reactions in children can be difficult due to the coexistence of indistinguishable symptoms in their history and DPT, as well as the need for multiple provocation tests. Therefore, further research is needed on this subject.