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Prevalence of Drugs as Triggers of Exacerbations in Chronic Urticaria

Sánchez J1,2, Sánchez A1,2,3, Cardona R1,2

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) : 112-117
doi: 10.18176/jiaci.0287

Background: Many patients with chronic spontaneous urticaria (CSU) report various drugs as triggers of their symptoms and often avoid medication unnecessarily.
Objective: To estimate the clinical impact of the drugs patients most frequently suspect of inducing CSU exacerbations.
Methods: The prevalence of self-reported drug reactions was evaluated by questioning patients about their clinical history of urticaria and drug reactions and performing challenge tests with the suspect drugs. A group of healthy persons were included as controls to evaluate the prevalence of self-reported drug reactions.
Results: The study population comprised 245 patients with CSU and 127 healthy individuals. At least 1 adverse drug reaction was reported by 92 (37.5%) patients and 30 (23.6%) controls. Nonsteroidal anti-inflammatory drugs (NSAIDs) (27.7%) and ß-lactams (9.4%) were the most commonly reported drugs in the CSU group and the control group, respectively. Positive results in the challenge tests were less common than self-reports in the CSU group (13%) and the control group (0.7%).
Conclusion: Self-reporting is generally not sufficient to confirm a drug reaction. Drug reactions to NSAIDs and ß-lactams are more frequent among patients who experience CSU than in those who do not. Drug challenge tests should be offered early during medical evaluation to avoid unnecessary restrictions.

Key words: Urticaria, Angioedema, Drugs, Aspirin, NSAIDs, Atopy, Oral challenge