Bedeutung von oralen provokationstestungen bei patienten mit unvertraglichkeitsreaktionen auf analgetika und NSAR

Mild analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) such as salicylates, pyrazolones, p-aminophenols and others are well-known elicitors of anaphylactoid reactions (ARs) and other adverse reactions including a variety of exanthematous drug eruptions (EX). 352 patients with a history of adverse reactions to analgesics/NSAIDs were investigated (sex: f = 229, m = 123; age 7-85 y.; AR: n = 292, EX n = 60). 75/352 patients (21%) were orally challenged with alternative substances in order to test their tolerance. A mailed questionnaire inquired about adverse reactions occuring subsequent to the allergy diagnosis [time interval: 0.5-3.5 y.; 40% response rate (n = 142); sex: f = 95, m = 47; age: 14-87 y.]. In 6/202 OPT (3%) patients did not tolerate the alternative preparation. 91/142 patients had re-used analgesics/NSAIDs in this time interval, and 10/91 (11%) reported an AR: 7 patients reacted to analgesic preparations not tested earlier by OPT, 2 reacted to a drug tolerated in an OPT, and 1 patient reacted to the accidentally re-used previous elicitor of an AR. There were 9 ARs to NSAIDs (7 of them severe) in patients who had tolerated paracetamol (acetaminohen). We conclude that patients with ARs to analgesics/NSAIDs benefit from allergy diagnosis including OPTs. It is important to test a standard battery of different analgesics/NSAIDs and not only a single substance e.g. acetaminophen. Patients should be advised to stick to the results of OPT. With only 2 out of 91 patients (2,2%) having 'false negative' results OPT under standardized conditions is by far the best available method in allergy diagnosis of drug allergy.