Phenotypical characterization of children with hypersensitivity reactions to <scp>NSAID</scp>s

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Non‐steroidal anti‐inflammatory drugs (NSAIDs) are the main cause of drug‐induced hypersensitivity in children. Many classifications have been proposed, focusing on adults. So far, no large study has deeply investigated a pediatric cohort. The aim of the present study was to describe a population of <jats:styled-content style="fixed-case">NSAID</jats:styled-content> hypersensitive patients reporting a reaction during their childhood and to verify whether it is possible to classify pediatric patients, following the <jats:styled-content style="fixed-case">EAACI</jats:styled-content>/<jats:styled-content style="fixed-case">ENDA</jats:styled-content> classification.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a historical prospective study including patients evaluated from 1996 to 2015 in the allergy unit of the Montpellier University Hospital. We included 635 patients. For each patient, we recorded clinical manifestations and possible comorbidities and tried to identify possible risk factors.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p><jats:styled-content style="fixed-case">NSAID</jats:styled-content> hypersensitivity was diagnosed in 107 of 635 patients (16.9%). In this group, 43 patients (40.2%) could not be classified following the <jats:styled-content style="fixed-case">ENDA</jats:styled-content> recommendations. The main discrepancies were on the patients’ clinical manifestations and on their possible underlying diseases. We identified, on a multivariate analysis, some risk factors for <jats:styled-content style="fixed-case">NSAID</jats:styled-content> hypersensitivity: chronic urticaria (<jats:styled-content style="fixed-case">OR</jats:styled-content> 7.737, 3.375–18.296 95%<jats:styled-content style="fixed-case">CI</jats:styled-content>), atopic status (<jats:styled-content style="fixed-case">OR</jats:styled-content> 2.514, 1.504–4.364 95%<jats:styled-content style="fixed-case">CI</jats:styled-content>), and allergic rhinoconjunctivitis (<jats:styled-content style="fixed-case">OR</jats:styled-content> 1.799, 1.138–2.837 95%<jats:styled-content style="fixed-case">CI</jats:styled-content>). On the basis of our results, we are proposing an adapted classification for <jats:styled-content style="fixed-case">NSAID</jats:styled-content> hypersensitivity in children.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The current <jats:styled-content style="fixed-case">ENDA</jats:styled-content> classification does not seem to be adapted for pediatric patients; a modified version does. Our study could help allergists better understand the differences between adults and children in developing hypersensitivity reactions to <jats:styled-content style="fixed-case">NSAID</jats:styled-content>s, but further large‐scale prospective longitudinal analyses are required to validate this new classification.</jats:p></jats:sec>