Aspirin-induced recurrent urticaria and recurrent angioedema in non-atopic children

Area of Science:

• Pediatric Allergy and Immunology
• Clinical Immunology
• Pharmacovigilance

Background:

• Recurrent urticaria and angioedema are common adverse drug reactions.
• Aspirin intolerance is a known cause of these reactions, particularly in non-atopic individuals.
• The prevalence and diagnostic confirmation in pediatric populations warrant further investigation.

Purpose of the Study:

• To investigate the occurrence of recurrent urticaria and angioedema in non-atopic children.
• To confirm aspirin intolerance through oral challenge in affected pediatric patients.
• To assess the reliability of patient history in identifying aspirin intolerance.

Main Methods:

• Retrospective analysis of 1,632 new patient visits to an allergy department.
• Clinical evaluation for atopy, including personal/family history, skin testing, eosinophil counts, and total IgE.
• Diagnostic confirmation of aspirin intolerance via standardized oral aspirin challenge.

Main Results:

• Nine out of 1,632 children (0.55%) presented with recurrent urticaria or angioedema after aspirin exposure.
• All nine patients showed no evidence of atopy.
• Oral aspirin challenge confirmed intolerance in all nine patients, despite only three reporting it historically.

Conclusions:

• Aspirin intolerance is a significant, often underreported, cause of recurrent urticaria and angioedema in non-atopic children.
• Clinical history alone is insufficient for diagnosing aspirin intolerance in this population.
• Oral aspirin challenge is crucial for accurate diagnosis and management of suspected aspirin-induced reactions in children.