Anaphylaxis to non-opioid analgesics, antipyretics and non-steroidal anti-inflammatory drugs: Analysis of the cases reported to the French Allergy-Vigilance Network from 2002 to 2020

Non-opioid analgesics, antipyretics and non-steroidal anti-inflammatory drugs are the second cause of drug hypersensitivity and a major cause of drug-induced anaphylaxis. In this retrospective study, we analyzed epidemiological, demographic and clinical characteristics of the cases of anaphylaxis induced by these drugs and collected by the French Allergy-Vigilance Network (RAV) from 2002 to 2020 and compared our results with those of Pharmacovigilance, French and international data. One hundred and fourteen cases were collected. This number is very low, as compared with the French Pharmacovigilance data (1498), due to a low number of allergists who reported these cases to the RAV. Although the documentation of cases was not homogeneous (patient's medical history, risk factors, allergological work-up), our results are nearly similar to those of the French and international data. They confirm that these drugs are the second cause of drug-induced anaphylaxis, often secondary to self-medication with paracetamol and ibuprofen. They also confirm that hypersensitivity to these drugs is more frequent in adults than in children, that a personal atopy is a risk factor for allergic hypersensitivity, and that anaphylactic reactions are undertreated (underuse of epinephrine). They also suggest that reactions due to allergic hypersensitivity are more frequent in children than in adults. Finally, our results confirm that the diagnostic value of skin tests, specific IgE determinations and basophil activation tests is low, and that diagnosis of HS to these drugs is mainly based on a suggestive clinical history and/or provocation tests. (C) 2021 Elsevier Masson SAS. All rights reserved.