Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jul-Aug;2(4):414-20.
doi: 10.1016/j.jaip.2014.03.014. Epub 2014 May 23.

Nonsteroidal anti-inflammatory drugs are major causes of drug-induced anaphylaxis

Marcelo Vivolo Aun  1 , Miguel Blanca  2 , Laila Sabino Garro  3 , Marisa Rosimeire Ribeiro  3 , Jorge Kalil  3 , Antonio Abilio Motta  3 , Mariana Castells  4 , Pedro Giavina-Bianchi  5
Affiliations

Nonsteroidal anti-inflammatory drugs are major causes of drug-induced anaphylaxis

Marcelo Vivolo Aun et al. J Allergy Clin Immunol Pract. 2014 Jul-Aug.

Abstract

Background: Drugs are responsible for 40% to 60% of anaphylactic reactions treated in the emergency department. A global research agenda to address uncertainties in anaphylaxis includes studies that identify factors associated with morbidity and mortality.

Objective: The present study investigated drug-induced anaphylaxis, etiologies, aggravating factors, and treatment.

Methods: A total of 806 patients with adverse drug reactions were screened, and those who had a clinical diagnosis of anaphylaxis were included in the study. Clinical and demographic characteristics of anaphylaxis were described, including etiologies, pathophysiologic mechanisms involved in the reactions, and a personal history of atopy and asthma. Factors associated with disease severity also were identified.

Results: Anaphylaxis was diagnosed in 117 patients (14.5%). The etiologies were defined in 76% of the cases, nonsteroidal anti-inflammatory drugs being the most frequent. Seventy-eight patients (66.7%) reported a previous reaction to the drug involved in the current reaction or to a drug from the same class and/or group. Epinephrine was used to treat 34.2% of patients who presented with anaphylaxis, and 40.8% of those with anaphylactic reactions with cardiovascular involvement. IgE-mediated reactions were associated with greater severity, manifested by the rates of cardiovascular dysfunction, hospitalization, and use of epinephrine.

Conclusions: The prevalence of anaphylaxis is high in patients who seek medical assistance for drug reactions, but its diagnosis is missed in emergency services, and adrenaline is underused. Drugs were prescribed to many patients despite a history of previous reaction. Nonsteroidal anti-inflammatory drugs were implicated in most cases of anaphylaxis induced by drugs, and IgE-mediated reactions were less frequent but more severe.

Keywords: Adverse drug reaction; Anaphylaxis; Epinephrine; Hypertensively reaction; IgE mediated; Nonsteroidal anti-inflammatory drugs.

PubMed Disclaimer

Comment in

  • Drug-induced anaphylaxis in children: nonsteroidal anti-inflammatory drugs and drug provocation test.
    Ensina LF, de Lacerda AE, de Andrade DM, Machado L, Camelo-Nunes I, Solé D. Ensina LF, et al. J Allergy Clin Immunol Pract. 2014 Nov-Dec;2(6):825. doi: 10.1016/j.jaip.2014.08.016. Epub 2014 Nov 6. J Allergy Clin Immunol Pract. 2014. PMID: 25439388 No abstract available.
  • Reply: To PMID 25017529.
    Aun MV, Blanca M, Garro LS, Ribeiro MR, Kalil J, Motta AA, Castells M, Giavina-Bianchi P. Aun MV, et al. J Allergy Clin Immunol Pract. 2014 Nov-Dec;2(6):826. doi: 10.1016/j.jaip.2014.08.015. Epub 2014 Nov 6. J Allergy Clin Immunol Pract. 2014. PMID: 25439389 No abstract available.

Similar articles

  • Drug-Induced Anaphylaxis in Latin American Countries.
    Jares EJ, Baena-Cagnani CE, Sánchez-Borges M, Ensina LF, Arias-Cruz A, Gómez M, Cuello MN, Morfin-Maciel BM, De Falco A, Barayazarra S, Bernstein JA, Serrano C, Monsell S, Schuhl J, Cardona-Villa R; Latin America Drug Allergy Interest Group. Jares EJ, et al. J Allergy Clin Immunol Pract. 2015 Sep-Oct;3(5):780-8. doi: 10.1016/j.jaip.2015.05.012. Epub 2015 Jul 2. J Allergy Clin Immunol Pract. 2015. PMID: 26143020
  • Drug-induced anaphylaxis in children: nonsteroidal anti-inflammatory drugs and drug provocation test.
    Ensina LF, de Lacerda AE, de Andrade DM, Machado L, Camelo-Nunes I, Solé D. Ensina LF, et al. J Allergy Clin Immunol Pract. 2014 Nov-Dec;2(6):825. doi: 10.1016/j.jaip.2014.08.016. Epub 2014 Nov 6. J Allergy Clin Immunol Pract. 2014. PMID: 25439388 No abstract available.
  • Multinational experience with hypersensitivity drug reactions in Latin America.
    Jares EJ, Sánchez-Borges M, Cardona-Villa R, Ensina LF, Arias-Cruz A, Gómez M, Barayazarra S, Bernstein JA, Serrano CD, Cuello MN, Morfin-Maciel BM, De Falco A, Cherrez-Ojeda I; Latin America Drug Allergy Interest Group. Jares EJ, et al. Ann Allergy Asthma Immunol. 2014 Sep;113(3):282-9. doi: 10.1016/j.anai.2014.06.019. Epub 2014 Jul 24. Ann Allergy Asthma Immunol. 2014. PMID: 25065979
  • Anaphylaxis: a review of 601 cases.
    Webb LM, Lieberman P. Webb LM, et al. Ann Allergy Asthma Immunol. 2006 Jul;97(1):39-43. doi: 10.1016/S1081-1206(10)61367-1. Ann Allergy Asthma Immunol. 2006. PMID: 16892779 Review.
  • [Anaphylaxis. Diagnostic and therapeutic management].
    Rietschel E, Hutegger I, Lange L, Urbanek R. Rietschel E, et al. Med Klin Intensivmed Notfmed. 2013 Apr;108(3):239-49; quiz 250-1. doi: 10.1007/s00063-013-0247-x. Med Klin Intensivmed Notfmed. 2013. PMID: 23595695 Review. German.
See all similar articles

Cited by

See all "Cited by" articles

MeSH terms

LinkOut - more resources