Guiding Drug Provocation Testing for Ibuprofen Hypersensitivity in a Pediatric Population: Development of the I3A Risk-Stratification Tool

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-03-01 DOI:10.1016/j.jaip.2024.11.022

Florian Stehlin MD , Connor Prosty MD , Angela Mulé BSc , Ibtihal Al-Otaibi MD , Luca Delli Colli MD , Judy Gaffar MD , Joshua Yu MD , Derek Lanoue MD, MEcon , Ana-Maria Copaescu MD , Moshe Ben-Shoshan MD, MSc

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引用次数: 0

Abstract

Background

Ibuprofen is a main cause of drug hypersensitivity reactions in children. The gold standard for diagnosis is the drug provocation test (DPT).

Objective

We aimed to create a clinical risk-stratification tool to guide this high-risk procedure.

Methods

We prospectively recruited children with suspected ibuprofen hypersensitivity between January 2017 and March 2024. Using stepwise bidirectional multivariable logistic regression, we calculated a predictive score for a positive ibuprofen DPT.

Results

Eighty-two patients with a median age of 5.9 years (interquartile range: 3.4-11.1 years) had an ibuprofen DPT. Eighteen (22.0%) patients had a positive challenge, with an anaphylactic reaction for 11 (61.1%). The I3A score (acronym for ibuprofen, 3As: angioedema, anaphylaxis, age, cutoff of 3) encompasses the following items: angioedema (2 points), anaphylaxis (1 point), and age at reaction ≥10 years old (1 point). The area under the curve of the I3A score was 0.84, and the optimal cutoff of <3 conferred a sensitivity of 84.4% (95% confidence interval [CI]: 66.7%-100.0%) and a specificity of 83.3% (95% CI: 75.0%-92.2%). The negative predictive value was estimated at 94.7% (95% CI: 90.0%-100.0%), and the positive predictive value at 60.0% (95% CI: 46.2%-76.2%). The relative risk of reacting to a challenge in the group I3A 3-4 compared with 0-2 was 11.4 (95% CI: 3.62%-35.7%, P < .001). Anaphylaxis after DPT was observed in 9 of 25 (36.0% [95% CI: 16.0%-56.0%]) in the high-risk group as compared with 2 of 57 (3.5% [95% CI: 0.0%-8.8%]) in the low-risk group (relative risk 10.3 [95% CI: 2.4%-43.5%]).

Conclusions

We generated a risk-stratification tool to identify children at low risk of reacting to ibuprofen challenges. Further validation is required in external cohorts.

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指导儿童人群布洛芬过敏的药物激发试验：I3A风险分层工具的发展

背景：布洛芬是儿童药物超敏反应的主要原因。诊断的金标准是药物激发试验（DPT）。目的：我们旨在创建一个临床风险分层工具来指导这种高风险手术。方法：前瞻性招募2017年1月至2024年3月期间疑似布洛芬过敏的儿童。使用逐步双向多变量逻辑回归，我们计算了布洛芬DPT阳性的预测评分。结果：82例患者中位年龄为5.9岁（IQR: 3.4;11.1），接受布洛芬DPT治疗。18例（22.0%）感染呈阳性，11例（61.1%）发生过敏反应。I3A评分（布洛芬的首字母缩写，3a：血管性水肿，过敏反应，年龄，截止时间为3）包括以下项目：血管性水肿（2分），过敏反应（1分）和反应年龄≥10岁（1分）。I3A评分的AUC为0.84，结论：我们建立了一个风险分层工具，以识别对布洛芬挑战反应的低风险儿童。需要在外部队列中进一步验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.