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Hipersensibilidad a los AINE de reacción cruzada: hallazgos clínicos de las pruebas de provocación de aspirina y de
Young-Il Koh1, Ji Eun Yu1, Da Woon Sim1
1Division of Allergy, Asthma and Clinical Immunology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea.
Clinical and translational science
|September 2, 2025
Resumen
El diagnóstico preciso de la hipersensibilidad a los antiinflamatorios no esteroideos (AINE) requiere pruebas de provocación, no solo antecedentes clínicos. Este estudio confirma la seguridad y eficacia de la provocación con aspirina y las pruebas de fármacos alternativos para el tratamiento de la hipersensibilidad a los AINE.
Área de la Ciencia:
- Alergia e inmunología
- Farmacología clínica
- Farmacovigilancia de las sustancias
Sus antecedentes:
- La hipersensibilidad a los antiinflamatorios no esteroideos (AINE) se diagnostica con frecuencia basándose únicamente en los antecedentes clínicos.
- El diagnóstico preciso es crítico para el manejo del paciente y evitar la evitación innecesaria de medicamentos.
Objetivo del estudio:
- Evaluar las manifestaciones clínicas de la hipersensibilidad a los AINE.
- Evaluar el valor diagnóstico y la seguridad de las pruebas de provocación oral de aspirina.
- Para investigar la tolerabilidad de medicamentos alternativos como el paracetamol, el meloxicam y el celecoxib.
Principales métodos:
- Análisis retrospectivo de pacientes diagnosticados con hipersensibilidad a los AINE mediante pruebas de provocación con aspirina.
- Clasificación de los pacientes en fenotipos: enfermedad cutánea exacerbada por AINE, enfermedad respiratoria, urticaria/angioedema y reacciones mixtas.
- Análisis de las pruebas de provocación oral con fármacos alternativos (acetaminofén, meloxicam, celecoxib) y seguimiento de eventos adversos.
Principales resultados:
- La provocación con aspirina confirmó la hipersensibilidad a los AINE en el 74,1% de los casos sospechosos.
- Altas tasas de tolerabilidad para medicamentos alternativos: acetaminofén (90%), meloxicam (96%) y celecoxib (98%).
- Las pruebas de provocación fueron seguras en entornos ambulatorios, sin hospitalizaciones o muertes, aunque se necesitó epinefrina en el 19,4% de los casos.
Conclusiones:
- Los antecedentes clínicos son insuficientes para diagnosticar la hipersensibilidad a los AINE; las pruebas de confirmación son esenciales.
- La provocación de aspirina y las pruebas secuenciales de drogas alternativas son seguras y efectivas cuando son realizadas por alergólogos.
- Las pruebas de confirmación facilitan la eliminación precisa de etiquetas y evitan el uso innecesario de medicamentos cruciales.
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