Predictive value of a negative oral provocation test in patients with hypersensitivity to analgesics

english

2016

volume 25, issue 2

hypersensitivity   negative predictive value   NSAIDs   oral provocation tests

Združenje slovenskih dermatovenerologov
(Obvezni izvod spletne publikacije)

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) take first or second place as the cause of drug-induced hypersensitivity reactions. The oral provocation test (OPT) is a gold standard for the diagnosis of NSAID hypersensitivity. We investigated which analgesics patients took after a negative OPT and determined the proportion of patients that experienced a hypersensitivity reaction despite a negative OPT. Methods: We selected 115 patients (67.8% female, age 54.9 % 16.7 years) with a negative aspirin OPT and a convincing history of immediate hypersensitivity to aspirin or NSAIDs. In a telephone survey, we identified the analgesics taken after the OPT and possible adverse events. Results: The mean follow-up time was 5.1 % 2.0 years. All subjects needed at least one analgesic drug. Despite the negative outcome of the aspirin OPT, only 33.9% of subjects took aspirin and 0.9% had a hypersensitivity reaction. The negative predictive value (NPV) of the aspirin OPT was 97.4%. Overall, 16 (13.9%) subjects experienced a hypersensitivity reaction, 12 of which occurred after taking a drug not tested with the OPT. The NPV of the OPT for all NSAIDs was 96.4%. Conclusions: Our results support the available data that most subjects do not re-take the tested drug regardless of the high NPV of the OPT.

30.03.2017