Hypersensitivity to Ibuprofen: Real-Life Experience in Children With History of Suspected Immediate Reactions

To evaluate the frequency, clinical characteristics, and risk factors of confirmed ibuprofen allergy in children presenting with suspected immediate hypersensitivity.

Children referred to pediatric allergy clinic with suspected immediate hypersensitivity reaction to ibuprofen between January 2015 and February 2020 were included in the study. Patients less than one year of age and those who refused to undergo drug provocation test (DPT) were excluded. A total of 50 subjects ages 5 to 17 years, 35 male, and 15 females participated.

Demographic information, characteristics of ibuprofen reactions, history of drug allergy, previously tolerated nonsteroidal anti-inflammatory drugs (NSAID), and presence of allergic disease was collected for each subject. Atopy was evaluated based on serum IgE and skin prick test to major inhalant and food allergens. Fifty patients were considered for DPT to ibuprofen. Eight patients had a history diagnostic for immediate ibuprofen anaphylaxis and DPT was deferred. Forty two patients completed DPT to ibuprofen. Additional DPT to aspirin was offered to subjects who reacted to ibuprofen to determine allergy to multiple NSAIDs.

Nine of 42 (21.4%) subjects had a positive ibuprofen DPT. Urticaria and angioedema developed in 6 patients, angioedema in isolation in two patients, and one had symptoms consistent with anaphylaxis. Ibuprofen allergy was confirmed in 17 (9 confirmed by DPT and 8 by history alone) of the 50 subjects (34%). Male gender and older age were independent risk factors for ibuprofen allergy. Attempts to assess the 17 patients as cross intolerant to other NSAIDS or selective reactive to ibuprofen was limited by the majority of families refusing additional DPT.

Male gender and older age are risk factors for ibuprofen allergy. DPT should be used to evaluate suspected ibuprofen allergy and find safe alternatives and determine if other NSAIDs would be tolerated.

History of adverse reactions to ibuprofen is not uncommon in pediatric patients. Without available validated allergy testing agents, DPT is essential in evaluating ibuprofen allergy. Additional studies assessing characteristics for selecting which patient should undergo drug challenges would be helpful. By evaluating these patients early, we may be able to prevent falsely labeling NSAID allergy, thus allowing potential effective therapies.