Negative predictive value of provocation tests for nonsteroidal anti-inflammatory drugs in children

Background: After antibiotics, nonsteroidal anti-inflammatory drugs (NSAID) are one of the leading drug classes responsible for hypersensitivity reactions in children. The drug provocation test (DPT) is the criterion standard for diagnosis. Objective: The aim of the present study was to determine the negative predictive values (NPV) of DPTs with NSAIDs in pediatric patients and to evaluate their attitudes toward NSAID use after a negative DPT result. Methods: The study included all patients who had undergone DPTs between January 1, 2014, and December 31, 2018, in our pediatric allergy clinic for suspected NSAID hypersensitivity reaction and who had a negative result for the suspected agent. Those patients who could be contacted were asked whether the patient had used the same drug again since the DPT and, if so, whether he or she had a reaction. Patients who were reported to have had a reaction were invited to the clinic for reevaluation. Based on the findings from this retesting, the NPVs of the DPTs with NSAIDs were calculated. Results: During the 5-year study period, DPT results were negative for 230 suspected agents in 215 patients. Of these, 143 patients (66.5%) were able to be contacted. A total of 108 patients (75.5%) had used the tested NSAIDs at least once after the provocation test, and five patients (4.6%) reported a reaction on reexposure. Four of these patients declined reevaluation, one patient exhibited no reaction in a second DPT. Therefore, the NPV was calculated as 96.3% (94.3% for ibuprofen, and 100% for paracetamol). Conclusion: The NPVs of DPTs with NSAIDs, especially of paracetamol DPT, is high in children. This finding should reassure the parents of patients who may require NSAID therapy again.