Drug hypersensitivity reactions (DHR) in asthmatic

patientsAuthors: Edgardo JARES, Carlos E. BAENA-CAGNANI, Mario

SÁNCHEZ BORGES, Luis ENSINA, Alfredo ARIAS CRUZ, Maximilano GÓMEZ, Blanca MORFIN MACIEL, Silvana MONSELL, Susana DIEZ-

ZULUAGA, Sandra GONZÁLEZ DÍAZ, Galie MIMESSI, Alejandra MACIAS WEINMANN, Dirceu SOLE, Carlos SERRANO,  Susana BARAYAZARRA, Iván CHERREZ, Mabel CUELLO, Paola TOCHE

PINAUD, Viviana Andrea ZANACCHI, Ricardo CARDONA VILLA

Affiliations: Fundación LIBRA (LIBRA Foundation)

Slaai Drug allergy Committee  

Adverse reactions to drugs are a frequent reason for consultation. There are few studies featuring these reactions in asthmatic patients.

Tolerability to etoricoxib in patients with aspirin-exacerbated respiratory disease. AERD (Aspirin-exacerbated respiratory disease) 248 aspirin challenges, 49.2%+, 97% tolerated

etoricoxib (only 3 positive challenges)

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Koschel D, Weber CN, Höffken G. J Investig Allergol Clin Immunol. 2013;23(4):275-80.)

Adverse reactions to drugs are a frequent reason for consultation. There are few studies featuring these reactions in asthmatic patients.

Mediator release after nasal aspirin provocation supports different phenotypes in subjects with hypersensitivity reactions to NSAIDs. 25 MNSAID-UA, 60 AERD. Lysine nasal challenge + 12% vs 80% ECP, PGD2 , LTD4 , LTE4 and triptase levels after

challenge in AERD but not in MNSAID‐UA MNSAID-UA and AERD have a distinctive phenotype

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Campo P et al. Allergy. 2013 Aug;68(8):1001-7.

Objectives:

Identify peculiarities of drug hypersensitivity reactions in asthmatic patients.  

Methods:

A descriptive cross-sectional study using ENDA questionnaire was carried out, reporting those patients seen in the last 2

years due to DHR.  Causal relationship was categorized into certain,

probable, possible, unlikely, and conditional, according to WHO-UMC Causality Categories (1).

Severity was graded as mild, moderate and severe (2).   Patients with asthma diagnosis (clinical and functional)

were selected.  

1) http://who-umc.org/Graphics/24734.pdf 2) http://www.anmat.gov.ar/farmacovigilancia/docs/Guia_BPF.pdf

Methods: Anaphylaxis was defined as a moderate or severe

reaction occurring less than 24 hours after the administration of the drug, with urticaria and/or angioedema (U/A), and respiratory (cough, dysphonia, dyspnea, wheezing/bronchospasm, rhinitis, rhinorrhea, sneezing, nasal obstruction), and/or gastrointestinal (nausea/emesis, diarrhea, gastrointestinal cramps) (R-GI) and/or cardiovascular (tachycardia, hypotension, collapse, arrhythmia) symptoms (CV) (3,4)

Causal drugs, clinical features and severity were compared with patients without asthma.

OpenEpi software was used. All reported P values were based on 2-tailed tests; values lower than .05 were considered statistically significant.

3) Sampson HA, et al. Second symposium on the definition and management of anaphylaxis: summary report. J Allergy Clin Immunol. 2006;117:391-7. 4) Simons FER, et al, for the World Allergy Organization: WAO guidelines for the assessment and management of anaphylaxis. J Allergy Clin Immunol. 2011;127:587-93.

Results

868 DHR in 862 patients were evaluated. 143 DHR occurred in 135 asthma patients.

Female gender was predominant.

Results: Clinical picture of the reactions

Table 1: HDR asthma n (%) no asthma n (%) p OR Urticaria/angioedema 102 (71.3) 505 (69.7) ns

Exanthema 21 (14.7) 164 (22.6) <0.05 0.59 (0.35-0.95)

Anaphylaxis 56 (39.2) 208 (28.7) <0.05 1.6 (1.1-2.3)

Respiratory symptoms 61 (42.7) 191 (26.3) <0.0001 2.08 (1.43-3)

Being asthmatic implied a 60% increased risk of having anaphylaxis because of DHR, but a duplicated risk of respiratory symptoms.

Respiratory Symptoms

Symptoms Asthma n (%)

No Asthma n (%) p OR

Respiratory Symptoms 61 (42.7) 191 (26.3) <0.0001 2.08

Disnea 46 (32.1) 155 (21.3) <0.01 1.74

Cougth 36 (25.1) 81 (11.1) <0.0001 2.67

Disphonia 11 (7.6) 70 (9.7) NS 0.7

Wheezing-bronchospasm 24 (16.7) 50 (6.9) <0.001 2.72

There was no significant difference in severity between groups.

No Asthmatic Patients Asthmatic Patients

Results: Main drug group responsible of DHR (certain and probable causal relationship)

Table 2: Drug Group

asthmatic n (%)

no asthmatic n (%)

P

NSAIDs 77 (57.9) 374 (50.2) ns Beta lactams antibiotics (BLAS)

16 (12) 103 (13.8) ns

Non beta lactams antibiotics (N-BLAS)

6 (4.5) 81 (10.9) <0.05

Conclusions

we identify that asthmatic patients have a significant higher risk of having anaphylactic reactions and respiratory symptoms during DHR. Caution should be taken to prevent these reactions, and provide the patients with an effective action plan.