Fatores de risco para o desenvolvimento de hipersensibilidade a anti-inflamatórios não-esteroidais – Revisão sistemática

Abstract

RISK FACTORS FOR DEVELOPMENT OF NON-STEROIDAL ANTI INFLAMMATORY HYPERSENSITIVITY– SYSTEMATIC REVIEW Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed drug classes worldwide, being the second most common cause of hypersensitivity reactions drug induced. Moreover, they are responsible for 21-25% of reported adverse reactions, including immunological and non-immunological hypersensitivity reactions. The prevalence of NSAIDs hypersensitivity varies from 0.6 to 5.7 % in the general population. Clinically, NSAIDs hypersensitivity is manifested by bronchial asthma, rhinosinusitis, anaphylaxis or hives, plus a variety of skin and organ-specific delayed reactions. Several studies have proved the relation of diseases associated with hypersensitivity to certain NSAIDs, especially aspirin and other specific inhibitors of COX-1. Among these diseases, the most important are bronchial asthma, chronic urticaria and nasal polyposis; they have higher prevalence of NSAIDs hypersensitivity than the general population. Objective: Identify articles in the medical literature concerning the risk factors for the development of hypersensitivity to NSAIDs. Methodology: Systematic review of the literature in the PubMed database, using a structured search strategy according to the descriptors: "Anti-Inflammatory Agents, Non-Steroidal", "Drug Hypersensitivity" and "Risk Factors”. Results: Fifteen articles were included for analysis. The risk factors found ("atopy", "chronic urticaria", "asthma" and "allergic rhinitis") were described in details; the tolerance to acetaminophen and nimesulide and selective COX-2 inhibitors were analyzed. Discussion: It was identified that the prevalence of hypersensitivity to NSAIDs is higher in certain risk groups, such as patients with bronchial asthma, chronic urticaria and atopic patients. The presence of hypersensitivity to NSAIDs seems to increase the prevalence of family history of allergic diseases. Patients with cross-intolerance to NSAIDs and paracetamol have higher risks of developing hypersensitivity reactions to selective COX-2 inhibitors. Conclusions: The potential risk factors associated with the development of hypersensitivity to nonsteroidal anti-inflammatory drugs include the personal history of atopy, personal history of chronic urticaria, associated with other allergic diseases such as asthma and rhinitis. Nimesulide and paracetamol are safe drugs alternatives for patients with hypersensitivity to NSAIDs. Selective cyclooxygenase (COX)-2 inhibitors are safe for use in patients with hypersensitivity to NSAIDs, but should be used with caution.