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Prevalence of drugs as triggers of exacerbations in chronic urticaria

J. Sánchez Jorge1,2, A. Sánchez1,2,3, R. Cardona1,2

1Group of Clinical and Experimental Allergy. IPS Universitaria, University of Antioquia, Medellin, Colombia.
2Foundation for the Development of Medical and Biological Sciences (FUNDEMEB), Cartagena, Colombia.
3Faculty of Medicine, Corporation University Rafael Nunez, Cartagena, Colombia.

J Investig Allergol Clin Immunol 2019; Vol. 29(2)
doi: 10.18176/jiaci.0287

Background: Many patients with chronic spontaneous urticaria (CSU) identify different drugs as triggers of their symptoms and often make restrictions without enough information.
Objective: To estimate the clinical impact of the drugs most frequently reported as suspects of CSU exacerbations by patients.
Methodology: All subjects were questioned about their clinical history of urticaria and drug reactions. Drug challenge tests were performed on each patient with the suspicious drugs. A group of healthy subjects were included as control to evaluate the prevalence of self-reported drug reactions.
Results: 245 patients with CSU and 127 healthy subjects were included. 92 (37.5%) patients and 30 (23,6%) subjects in the control group reported at least one adverse drug reaction. Non-steroidal anti-inflammatory drugs (NSAIDs) (27.7%) and Beta-lactams (9.4%) were the most common drugs reported by CSU group and the control group, respectively. Positive results of challenge tests were lower than self-reports in CSU (13%) and the control group (0.7%).
Conclusion: Self-report is usually not enough to determine a drug reaction. Drug reactions to NSAIDs and beta-lactams are higher among patients with CSU than in subjects without urticaria. Drug challenge tests should be offered early during medical evaluation to avoid unnecessary restrictions.

Key words: Urticaria, Angioedema, Drugs, Aspirin, NSAIDs