Alergia e intolerancia a antiinflamatorios no esteroides: desensibilización exitosa en tres casos y revisión de la literatura
Palabras clave:
hipersensibilidad a los medicamentos, aspirina, agentes antiinflamatorios no esteroides, desensibilización inmunológica, asma, anafilaxis, pólipos nasales, sinusitis
Resumen
Los antiinflamatorios no esteroides son la segunda causa de reacciones a medicamentos después de los beta-lactámicos. La prevalencia de las reacciones a antiinflamatorios no esteroideos en la población general es de 0,1% a 0,3% y la prevalencia de anafilaxia inducida por ellos es de 0,01%.La intolerancia al ácido acetilsalicílico o a los antiinflamatorios no esteroides se presenta con síntomas como urticaria aguda, angioedema, crisis asmática, enfermedad respiratoria exacerbada por ácido acetilsalicílico y anafilaxia.
Presentamos una revisión actualizada basada en tres casos de pacientes con intolerancia al ácido acetilsalicílico o a los antiinflamatorios no esteroideos que, por sus enfermedades concomitantes, requerían tratamiento permanente conácido acetilsalicílico. Después de someterlos a un protocolo de desensibilización rápida ácido acetilsalicílico en una unidad de cuidados intensivos, estos pacientes pudieron continuar recibiendo ácido acetilsalicílico diariamente sin efectos adversos.
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Referencias bibliográficas
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2. Sánchez-Borges M. Clinical management of nonsteroidal anti-inflammatory drug hypersensitivity. WAO Journal. 2008;1:29-33.
3. Jenneck C, Juergens U, Buecheler M, Novak N. Pathogenesis, diagnosis, and treatment of aspirin intolerance. Ann Allergy Asthma Immunol. 2007;99:13-21.
4. Cianferoni A, Novembre E, Mugnaini L, Lombardi E, Bernardini R, Pucci N, et al. Clinical features of acute anaphylaxis in patients admitted to a university hospital: an 11-year retrospective review (1985-1996). Ann Allergy Asthma Immunol. 2001;87:27-32.
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7. Settipane GA. Aspirin and allergic diseases: a review. Am J Med. 1983;74:102-9.
8. Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F. NSAID-induced urticaria and angioedema: a reappraisal of its clinical management. Am J Clin Dermatol. 2002;3:599-607.
9. Castells M. Desensitization for drug allergy. Curr Opin Allergy Clin Immunol. 2006;6:476-81.
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11. Gollapudi RR, Teirstein PS, Stevenson DD, Simon RA. Aspirin sensitivity: implications for patients with coronary artery disease. JAMA. 2004;292:3017-23.
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13. Sweet JM, Stevenson DD, Simon RA, Mathison DA. Long-term effects of aspirin desensitization-treatment for aspirin-sensitive rhinosinusitis-asthma. J Allergy Clin Immunol. 1990;85:59-65.
14. Stevenson DD, Hankammer MA, Mathison DA, Christiansen SC, Simon RA. Aspirin desensitization treatment of aspirin-sensitive patients with rhinosinusitis-asthma: long-term outcomes. J Allergy Clin Immunol. 1996;98:751-8.
15. Pfaar O, Klimek L. Aspirin desensitization in aspirin intolerance: update on current standards and recent impro-vements. Curr Opin Allergy Clin Immunol. 2006;6:161-6.
16. White AA, Stevenson DD, Simon RA. The blocking effect of essential controller medications during aspirin challenges in patients with aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol. 2005;95:330-5.
17. Stevenson DD, Simon RA. Selection of patients for aspirin desensitization treatment. J Allergy Clin Immunol. 2006;118:801-4.
18. Silberman S, Neukirch-Stoop C, Steg PG. Rapid desensitization procedure for patients with aspirin hypersensitivity undergoing coronary stenting. Am J Cardiol. 2005;95:509-10.
19. Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F. The multiple faces of nonsteroidal antiinflammatory drug hypersensitivity. J Investig Allergol Clin Immunol. 2004;14:329-34.
20. Stevenson DD. Aspirin and NSAID sensitivity. Immunol Allergy Clin North Am. 2004;24:491-505.
21. Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Reborg S, Haahtela T, et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001;56:813-24.
22. Andri L, Senna G, Betteli C, Givanni S, Scaricabarozzi I, Mezzelani P, et al. Tolerability of nimesulide in aspirin-sensitive patients. Ann Allergy. 1994;72:29-32.
23. Kosnik M, Music E, Matjaz F, Suskovic S. Relative safety of meloxicam in NSAID-intolerant patients. Allergy. 1998;53:1231-3.
24. Nettis E, Di Paola R, Ferrannini A, Tursi A. Meloxicam in hypersensitivity to NSAIDs. Allergy. 2001;56:803-4.
25. Quiralte J, Blanco C, Castillo R, Delgado J, Carrillo T. Intolerance to nonsteroidal antiinflammatory drugs: results of controlled drug challenges in 98 patients. J Allergy Clin Immunol. 1996;98:678-85.
26. Ruxrungtham K, Chantaphakul H, Tiyasatapon S, Phanupak P. Acetaminophen cross-sensitivity is common in Thai patients with aspirin/NSAIDs Sensitivity and may be life-threatening. J Allergy Clin Immunol. 2002;109:s141.
27. Zedlitz S, Linzbach L, Kaufmann R, Boehncke WH. Reproducible identification of the causative drug of a fixed drug eruption by oral provocation and lesional patch testing. Contact Derm. 2002;46:352-3.
28. Talhari C, Lauceviciute I, Enderlein E, Ruzicka T, Homey B. COX-2-selective inhibitor valdecoxib induces severe allergic skin reactions. J Allergy Clin Immunol. 2005;115:1089-90.
29. Pichler WJ, Tilch J. The lymphocyte transformation test in the diagnosis of drug hypersensitivity. Allergy. 2004;59:809-20.
30. Milewski M, Mastalerz L, Nizankowska E, Szczeklik A. Nasal provocation test with lysine-aspirin for diagnosis of aspirin-sensitive asthma. J Allergy Clin Immunol. 1998;101:581-6.
31. Nizankowska-Mogilnicka E, Bochenek G, Mastalerz L, Swierczynska M, Picado C, Scadding G, et al. EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivity. Allergy. 2007;62:1111-8.
2. Sánchez-Borges M. Clinical management of nonsteroidal anti-inflammatory drug hypersensitivity. WAO Journal. 2008;1:29-33.
3. Jenneck C, Juergens U, Buecheler M, Novak N. Pathogenesis, diagnosis, and treatment of aspirin intolerance. Ann Allergy Asthma Immunol. 2007;99:13-21.
4. Cianferoni A, Novembre E, Mugnaini L, Lombardi E, Bernardini R, Pucci N, et al. Clinical features of acute anaphylaxis in patients admitted to a university hospital: an 11-year retrospective review (1985-1996). Ann Allergy Asthma Immunol. 2001;87:27-32.
5. Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis, diagnosis, and management. J Allergy Clin Immunol. 2003;111:913-21.
6. Faich GA. Adverse-drug-reaction monitoring. N Engl J Med. 1986;314:1589-92.
7. Settipane GA. Aspirin and allergic diseases: a review. Am J Med. 1983;74:102-9.
8. Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F. NSAID-induced urticaria and angioedema: a reappraisal of its clinical management. Am J Clin Dermatol. 2002;3:599-607.
9. Castells M. Desensitization for drug allergy. Curr Opin Allergy Clin Immunol. 2006;6:476-81.
10. Berges-Gimeno MP, Simon RA, Stevenson DD. Long-term treatment with aspirin desensitization in asthmatic patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2003;111:180-6.
11. Gollapudi RR, Teirstein PS, Stevenson DD, Simon RA. Aspirin sensitivity: implications for patients with coronary artery disease. JAMA. 2004;292:3017-23.
12. Widal F, Abrami P, Lermoyez J. Anaphylaxie et idiosyncrasie. Presse Med. 1922;30:189-92.
13. Sweet JM, Stevenson DD, Simon RA, Mathison DA. Long-term effects of aspirin desensitization-treatment for aspirin-sensitive rhinosinusitis-asthma. J Allergy Clin Immunol. 1990;85:59-65.
14. Stevenson DD, Hankammer MA, Mathison DA, Christiansen SC, Simon RA. Aspirin desensitization treatment of aspirin-sensitive patients with rhinosinusitis-asthma: long-term outcomes. J Allergy Clin Immunol. 1996;98:751-8.
15. Pfaar O, Klimek L. Aspirin desensitization in aspirin intolerance: update on current standards and recent impro-vements. Curr Opin Allergy Clin Immunol. 2006;6:161-6.
16. White AA, Stevenson DD, Simon RA. The blocking effect of essential controller medications during aspirin challenges in patients with aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol. 2005;95:330-5.
17. Stevenson DD, Simon RA. Selection of patients for aspirin desensitization treatment. J Allergy Clin Immunol. 2006;118:801-4.
18. Silberman S, Neukirch-Stoop C, Steg PG. Rapid desensitization procedure for patients with aspirin hypersensitivity undergoing coronary stenting. Am J Cardiol. 2005;95:509-10.
19. Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F. The multiple faces of nonsteroidal antiinflammatory drug hypersensitivity. J Investig Allergol Clin Immunol. 2004;14:329-34.
20. Stevenson DD. Aspirin and NSAID sensitivity. Immunol Allergy Clin North Am. 2004;24:491-505.
21. Johansson SG, Hourihane JO, Bousquet J, Bruijnzeel-Koomen C, Reborg S, Haahtela T, et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001;56:813-24.
22. Andri L, Senna G, Betteli C, Givanni S, Scaricabarozzi I, Mezzelani P, et al. Tolerability of nimesulide in aspirin-sensitive patients. Ann Allergy. 1994;72:29-32.
23. Kosnik M, Music E, Matjaz F, Suskovic S. Relative safety of meloxicam in NSAID-intolerant patients. Allergy. 1998;53:1231-3.
24. Nettis E, Di Paola R, Ferrannini A, Tursi A. Meloxicam in hypersensitivity to NSAIDs. Allergy. 2001;56:803-4.
25. Quiralte J, Blanco C, Castillo R, Delgado J, Carrillo T. Intolerance to nonsteroidal antiinflammatory drugs: results of controlled drug challenges in 98 patients. J Allergy Clin Immunol. 1996;98:678-85.
26. Ruxrungtham K, Chantaphakul H, Tiyasatapon S, Phanupak P. Acetaminophen cross-sensitivity is common in Thai patients with aspirin/NSAIDs Sensitivity and may be life-threatening. J Allergy Clin Immunol. 2002;109:s141.
27. Zedlitz S, Linzbach L, Kaufmann R, Boehncke WH. Reproducible identification of the causative drug of a fixed drug eruption by oral provocation and lesional patch testing. Contact Derm. 2002;46:352-3.
28. Talhari C, Lauceviciute I, Enderlein E, Ruzicka T, Homey B. COX-2-selective inhibitor valdecoxib induces severe allergic skin reactions. J Allergy Clin Immunol. 2005;115:1089-90.
29. Pichler WJ, Tilch J. The lymphocyte transformation test in the diagnosis of drug hypersensitivity. Allergy. 2004;59:809-20.
30. Milewski M, Mastalerz L, Nizankowska E, Szczeklik A. Nasal provocation test with lysine-aspirin for diagnosis of aspirin-sensitive asthma. J Allergy Clin Immunol. 1998;101:581-6.
31. Nizankowska-Mogilnicka E, Bochenek G, Mastalerz L, Swierczynska M, Picado C, Scadding G, et al. EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivity. Allergy. 2007;62:1111-8.
Cómo citar
1.
Cardona R, Ramírez RH, Reina Z, Escobar MF, Morales E. Alergia e intolerancia a antiinflamatorios no esteroides: desensibilización exitosa en tres casos y revisión de la literatura. Biomed. [Internet]. 1 de junio de 2009 [citado 8 de abril de 2025];29(2):181-90. Disponible en: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/20
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