Assuntos
Antineoplásicos/uso terapêutico , Autoanticorpos/sangue , Cetuximab/uso terapêutico , Dessensibilização Imunológica/métodos , Imunoglobulina E/sangue , alfa-Galactosidase/imunologia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/secundário , Esquema de Medicação , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Neoplasias Faríngeas/tratamento farmacológico , Neoplasias Faríngeas/imunologia , Neoplasias Faríngeas/patologia , Seio Piriforme/efeitos dos fármacos , Seio Piriforme/imunologia , Seio Piriforme/patologia , Testes Cutâneos , alfa-Galactosidase/sangueAssuntos
Monitores de Pressão Arterial/efeitos adversos , Queimaduras Químicas/etiologia , Dermatite de Contato/etiologia , Desinfetantes/efeitos adversos , 1-Propanol/efeitos adversos , Idoso , Queimaduras Químicas/diagnóstico , Infecção Hospitalar/prevenção & controle , Dermatite de Contato/diagnóstico , Diagnóstico Diferencial , Desinfetantes/uso terapêutico , Contaminação de Equipamentos/prevenção & controle , Etanol/efeitos adversos , Feminino , Humanos , Masculino , Adulto JovemRESUMO
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent medicaments involved in drug hypersensitivity reactions, with NSAID-induced urticaria/angioedema (NIUA) being the most frequent clinical entity. The natural evolution of NIUA has been suggested to lead to chronic urticaria (CU) in an important proportion of patients, such that NIUA may therefore precede CU. Our aim was to verify whether these entities are related by following up a large cohort of patients with NIUA as well as a control group over a long period of time. METHODS: The study comprised three groups: (i) patients with a confirmed history of NIUA (more than two episodes with at least two different NSAIDs or positive drug provocation tests), (ii) patients with more than two episodes of urticaria/angioedema to a single NSAID with good tolerance to a strong COX-1 inhibitor and/or evidence by in vivo tests supporting specific IgE antibodies to the drug (single NSAID-induced urticaria/angioedema, SNIUA), and (iii) controls who tolerated NSAIDs. All cases in the three groups were followed up over a period of 12 years. RESULTS: There were 190 patients with NIUA (64.6% female; mean age 43.71 ± 15.82 years, 110 with SNIUA, and 152 controls. At the 12-year evaluation, 12 patients with NIUA (6.15%) had developed CU over a 1- to 8-year period. Similar proportions were seen in SNIUA and controls. CONCLUSIONS: Nonsteroidal anti-inflammatory drugs-induced urticaria/angioedema does not seem to precede the onset of CU over the medium term. Further research including a longer follow-up is necessary to verify this observation.
Assuntos
Angioedema/induzido quimicamente , Angioedema/imunologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Hipersensibilidade a Drogas/imunologia , Urticária/induzido quimicamente , Urticária/imunologia , Adolescente , Adulto , Angioedema/diagnóstico , Doença Crônica , Hipersensibilidade a Drogas/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Autorrelato , Fatores de Tempo , Urticária/diagnóstico , Adulto JovemRESUMO
BACKGROUND: Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) can affect children, with the mechanism proposed being inhibition of the cyclooxygenase enzyme-1 (COX-1). In these patients nonchemically related NSAIDs, including COX-2 inhibitors, can induce the reaction, hampering treatment of fever and inflammatory processes. OBJECTIVES: To analyse retrospectively tolerance to etoricoxib, a selective COX-2 inhibitor, and to meloxicam, a preferential COX-2 inhibitor, in children with hypersensitivity to NSAIDs. METHODS: Clinical records of children (aged 1-14 years) diagnosed with hypersensitivity reactions to NSAIDs from January 2006 to January 2013 were included. The diagnosis was confirmed by oral drug provocation test (DPT) with the culprit NSAIDs and acetylsalicylic acid (ASA). Tolerance to paracetamol, etoricoxib and meloxicam was also evaluated. RESULTS: The study included 41 children with a positive DPT with ASA and the culprit NSAID. DPT with paracetamol and etoricoxib was negative in all children, although two (4.9%) children developed a reaction after the administration of meloxicam. CONCLUSIONS: These data indicate that both etoricoxib and meloxicam are good alternatives for treatment in older children with hypersensitivity to NSAIDs.
