Guiding drug provocation testing for ibuprofen hypersensitivity in a pediatric population: Development of the I3A risk-stratification tool.

Autor:	Stehlin F; Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, Quebec, Canada; Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; The Research Institute of the McGill University Health Centre, McGill University, McGill University Health Centre (MUHC), Montreal, Quebec, Canada. Electronic address: florian.stehlin@chuv.ch., Prosty C; Division of Pediatric Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, Quebec, Canada., Mulé A; Division of Pediatric Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, Quebec, Canada., Al-Otaibi I; Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, Quebec, Canada; College of Medicine, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia., Colli LD; Division of Pediatric Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, Quebec, Canada., Gaffar J; Division of Ophtalmology, Université de Montréal, Montreal, Quebec, Canada., Yu J; Department of Medicine, McMaster University, Hamilton ON, Canada., Lanoue D; Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, Quebec, Canada; Department of Medicine, L'Hôpital Montfort, University of Ottawa, Ottawa, ON, Canada., Copaescu AM; Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre, McGill University, McGill University Health Centre (MUHC), Montreal, Quebec, Canada; Center for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia., Ben-Shoshan M; The Research Institute of the McGill University Health Centre, McGill University, McGill University Health Centre (MUHC), Montreal, Quebec, Canada; Division of Pediatric Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, Quebec, Canada.
Jazyk:	angličtina
Zdroj:	The journal of allergy and clinical immunology. In practice [J Allergy Clin Immunol Pract] 2024 Dec 03. Date of Electronic Publication: 2024 Dec 03.
DOI:	10.1016/j.jaip.2024.11.022
Abstrakt:	Background: Ibuprofen is a main cause of drug hypersensitivity reactions in children. The gold standard for diagnosis is the drug provocation test (DPT). Objective: We aimed to create a clinical risk-stratification tool to guide this high-risk procedure. Methods: We prospectively recruited children with suspected ibuprofen hypersensitivity between January 2017 and March 2024. Using stepwise bidirectional multivariable logistic regression, we calculated a predictive score for a positive ibuprofen DPT. Results: Eighty-two patients with a median age of 5.9 years (IQR: 3.4;11.1) had an ibuprofen DPT. Eighteen (22.0%) had a positive challenge, with an anaphylactic reaction for 11 (61.1%). The I3A score (acronym for Ibuprofen, 3As: Angioedema, Anaphylaxis, Age, Cut-off of 3) encompasses the following items: Angioedema (2 points), Anaphylaxis (1 point), and Age at reaction ≥ 10 years old (1 point). The AUC of the I3A score was 0.84 and the optimal cut-off of <3 conferred a sensitivity of 84.4% % (95% confidence interval [95%CI] 66.7-100.0%) and a specificity of 83.3% (95%CI 75.0-92.2%). The negative predictive value was estimated at 94.7% (95%CI 90.0-100.0%), and the positive predictive value at 60.0% (95%CI 46.2%-76.2%). The relative risk of reacting to challenge in the group I3A 3-4 compared to 0-2 was 11.4 (95CI% 3.62-35.7, p<0.001). Anaphylaxis following DPT was observed in 9/25 [36.0% (95%CI 16.0-56.0%)] in the high-risk group as compared to 2/57 [3.5% (95%CI 0.0-8.8%)] in the low-risk group [relative risk 10.3 (95%CI 2.4-43.5)]. Conclusion: We generated a risk stratification tool to identify children at low-risk of reacting to ibuprofen challenges. Further validation is required in external cohorts. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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