การแพ้ NSAID

Cross hypersensitivity Cross hypersensitivity Cross hypersensitivity Cross hypersensitivity of NSAIDsof NSAIDs

.

OUTLINEOUTLINE

Introduction to NSAIDs

Cross reactivity of NSAIDs in immediated type hypersensitivityyp yp y

Cross reactivity of NSAIDs in ydelayed type hypersensitivity of NSAIDs

Conclusions

I t d ti t NSAID Introduction to NSAIDs

NSAIDsNSAIDs

DelayedtypeImmediated type y yp

Urticaria, MP rash, Fixed drug eruption, Angioedema, Anaphylaxis DRESS, Drug hypersensitivity syndrome, SJS, TEN

Pseudoallergy True allergy True allergy

salicylates NSAIDs NSAIDs NSAIDs ImmediatedImmediated typetype

True allergy urticaria, angioedema anaphylaxis

Pseudoallergy IgE

PseudoallergyPseudoallergy True allergy True allergy ImmediatedImmediated typetype Pseudoallergy True allergy

Urticaria, Urticaria,Angioedema, Anaphylaxis Angioedema, Anaphylaxis

Cox I (PGE2 ) (IgE)

Cox I

NSAIDs Cox I

NSAIDs / Cox I

NSAIDs

11.. SalicylicacidsSalicylicacids

Cardiprin 100 Aggrenox B-aspirin Ascot

NSAIDs 22..Indol andindeneaceticacids

Indomethacin Sulindac

Indomed Clinoril

NSAIDs 33..Heteroaceticacids

Diclofenac

DosanacVoltaren Voltaren SR

Voltaren Ketorolac

NSAIDs 44..Arilpropionic acids

Ketoprofen Ibuprofen

Naproxen Loxoprofen

Heidi 200 mg Heidi 400 mg NurofenSynflex

Napxen,NapxenLoxonin

NSAIDs

5. Fenamates

Mefenamic acidMefenamic acidFloctafenine

Ponstan Idarac

NSAIDs

6. Oxicams

Feldene,Tilcotil ,Seftil Feldene, Flamic

MeloxicamPiroxicam

Mobic, Feldene-DTenoxicam LomoxicamMelcam

NSAIDs 7. Cox II inhibitor

Celebrex Celecoxib Rofecoxib

Valdecoxib Parecoxib Etoricoxib

Dynastat

Valdecoxib Parecoxib Etoricoxib

Arcoxia

Dynastat

Lumiracoxib Nimesulide

NSAIDsNSAIDs




NSAIDs NSAIDs PseudoallergyPseudoallergy : Urticaria, Angioedema, Anaphylaxis, Asthma

Cox I PGE (PGE Mast cell PGE2 (PGE2 Mast cell

stabilizer) Histamine mediators Cox I

Cox I

NSAIDs Cox 1. CoxI 2. Cox I

Cox I 3. CoxII

Cox I 4. CoxII

CoxI dose

CoxI dose

NSAIDs C I

Cox I dose

C I Cox

I

Cox I Cox I dose dose

Cox I I

AspirinIbuprofen

Paracetamol 1000 mg/dose

Meloxicam EtoricoxibParecoxib

IndomethacinDiclofenacPiroxicam

>1000mg/dose) Anaphylaxis

NSAIDs SulindacMefenamic acidFloctafenine Rachel U. Lee,1 Donald D. Stevenson2Aspirin-Exacerbated Respiratory Disease:Evaluation and ManagementAllergy Asthma Immunol Res. 2011 January;3(1):3-10.

NSAIDs

Pseudoallergy

.. 18 Ibuprofen 1 30

Diclofenac Piroxicam Diclofenac ,Piroxicam Sulindac

Pseudoallergy

NSAIDs NSAIDs . Paracetamol. Meloxicam Celecoxib. Celecoxib. Aspirin

1. CoxI 2. Cox I Cox I

3. CoxII Cox I

4. CoxII

NSAIDs Cox

CoxI dose

CoxI dose

NSAIDs C I

Cox I dose

C I Cox

I

Cox I Cox I dose dose

Cox I I

AspirinIbuprofen

Paracetamol 1000 mg/dose

Meloxicam EtoricoxibParecoxib

IndomethacinDiclofenacPiroxicam

>1000mg/dose) Anaphylaxis

NSAIDs SulindacMefenamic acidFloctafenine

Rachel U. Lee,1 Donald D. Stevenson2Aspirin-Exacerbated Respiratory Disease:Evaluation and ManagementAllergy Asthma Immunol Res. 2011 January;3(1):3-10.

NSAIDs

NSAIDs Psuedoallergy

/ CIU NSAIDs 1

NSAIDs > 1

Cross Reactivity

NSAIDs NSAIDs-

NSAIDs

- NSAIDs

NSAIDs anaphylaxis

NSAIDs NSAIDs True allergyTrue allergy

: Urticaria, Angioedema, Anaphylaxis, Asthma (IgE) 1 1 1 > 1

NSAIDs NSAIDs COX I NSAIDs

COX II1.Salicylic acids 2. Indol and

Indene 3. Heteroacetic

acids4.Arilpropionic acids

5.Fenamates 6.Oxicams 7.Cox-2 inhibitors

acetic acidsAscot,

B-aspirinIndomed

(Indomethacin)Voltaren,Dosanac

Nurofen, Heidi

Ponstan

(MefenamicFeldene, Flamic

Celebrex

(Celecoxib)Cardiprin, Aggrenox

(Aspirin)

(Diclofenac) (Ibuprofen) acid) (Piroxicam)

(Aspirin)Clinoril

(Sulindac)Ketalac

(Ketorolac)Synflex

(Naproxen)Idarac

(Floctafenine)Tilcotil, Seftil

(Tenoxicam)Dynastat

(Peracoxib)

Loxonin

(Loxoprofen)Mobic, Melox

(Meloxicam)Arcoxia

(Etoricoxib)

Anaphylaxis NSAIDs

True allergy

.. 18 Ibuprofen 1 30

Naproxen Naproxen Piroxicam Mefenamic acid

True allergy

NSAIDs NSAIDs . Diclofenac. Indomethacin Piroxcicam. Piroxcicam. Aspirin

NSAIDs NSAIDs COX I NSAIDs

COX II1.Salicylic acids 2. Indol and

Indene 3. Heteroacetic

acids4.Arilpropionic acids

5.Fenamates 6.Oxicams 7.Cox-2 inhibitors

acetic acidsAscot,

B-aspirinIndomed

(Indomethacin)Voltaren,Dosanac

Nurofen, Heidi

Ponstan

(MefenamicFeldene, Flamic

Celebrex

(Celecoxib)Cardiprin, Aggrenox

(Aspirin)

(Diclofenac) (Ibuprofen) acid) (Piroxicam)

(Aspirin)Clinoril

(Sulindac)Ketalac

(Ketorolac)Synflex

(Naproxen)Idarac

(Floctafenine)Tilcotil, Seftil

(Tenoxicam)Dynastat

(Peracoxib)

Loxonin

(Loxoprofen)Mobic, Melox

(Meloxicam)Arcoxia

(Etoricoxib)

NSAIDsCrossReactivity NSAIDs True allergy/ CIU NSAIDs

1 NSAIDs

> 1 Cross Reactivity

-

NSAIDs

anaphylaxis

- NSAIDs

NSAIDs

NSAIDsNSAIDs




NSAIDs Deleyed type reaction1 True allergy ( T cell)5- True allergy ( T cell)-

( Fixed drug eruption Oxicams) 6

SJS/TEN

NSAIDs NSAIDs

- NSAIDs

- Desensitization 1

CONCLUSIONSCONCLUSIONS

NSAIDs hypersensitivity Immediated Deleyed type Immediated type

NSAIDs True NSAIDs True Pseudo allergy


NSAIDs > 1 Pseudoallergy

NSAIDs Cox I NSAIDs Cox I Cox II inhibitor

Cox I Cox II ( 4%)


NSAIDs 1 > 1 True allergy

NSAID NSAIDs


Delayed type True allergy

NSAIDs NSAIDs

REFERENCEREFERENCE

1. Cuerda Galindo E, Goday Bujn JJ, Garca Silva JM, Martnez W, Verea Hernando M, Fonseca E. Fixed drug eruption from piroxicam.J Eur Acad DermatolVenereol. 2004 Sep;18(5):586-7.

2. Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bousquet J, Bousquet P, Celik G, Demoly P, Gomes ER, Niankowska-Mogilnicka E, Romano A, Sanchez-Borges M, Sanz M, Torres MJ, De Weck A, Szczeklik A, Brockow K. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA(#) and GA2LEN/HANNA*. Allergy. 2011 Jul;66(7):818-29. doi: 10.1111/j.1398-9995.2011.02557.x. Epub 2011 Feb 14.

3 K l SR D k AM W b EA Sh NH M t ti f ti t ith i i d t id l tii fl t d iti it3. Knowles SR, Drucker AM, Weber EA, Shear NH. Management options for patients with aspirin and nonsteroidal antiinflammatory drug sensitivity.Ann Pharmacother. 2007 Jul;41(7):1191-200. Epub 2007 Jul 3. Review.

4. Posadas SJ, Pichler WJ. Delayed drug hypersensitivity reactions - new concepts. Clin Exp Allergy. 2007 Jul;37(7):989-99.5. Snchez Borges M, Capriles-Hulett A, Caballero-Fonseca F, Prez CR. Tolerability to new COX-2 inhibitors in NSAID-sensitive patients with cutaneousg , p , , y p

reactions. Ann Allergy Asthma Immunol. 2001 Sep;87(3):201-4.6. Snchez Borges M, Capriles-Hulett A, Caballero-Fonseca F, Gonzalez- Aveledo L. Hypersensitivity reaction to Non steroidal Anti-inflammatory drugs : An

update. Pharmaceutical. 2010 Jan ; 3:10-18.7. Szczeklik A, Sanak M. The broken balance in aspirin hypersensitivity. Eur J Pharmacol. 2006 Mar 8;533(1-3):145-55. Epub 2006 Feb 7.

Asero R. Risk factors for acetaminophen and nimesulide intolerance in patients with NSAID-induced skin disorders. Ann Allergy Asthma Immunol. 1999 Jun;82(6):554-8.

การแพ้ NSAID

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