Novel Tool May Predict NSAID Hypersensitivity

Medscape

3 days ago

TOPLINE:
A new risk stratification tool known as CA4TCH — which relies solely on clinical history — could help predict which patients with a suspected hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) will have a hypersensitivity confirmed during a drug provocation test.
METHODOLOGY:
To develop and validate CA4TCH, researchers conducted a retrospective study of 1035 patients who presented with suspected NSAID hypersensitivity at the allergy unit of the University Hospital of Montpellier in Montpellier, France, between February 2001 and December 2020 and underwent drug provocation testing.
Using elements of the clinical history — including sex; age at the last reaction; reaction onset ≤ 24 hours; whether the last reaction occurred in the past 5 years; history of anaphylaxis or respiratory symptoms; reactions to two or more drug classes; reaction to aspirin; and comorbid atopy, asthma, sinus disease, or chronic spontaneous urticaria — the team constructed a risk score to predict the presence of a drug hypersensitivity reaction.
They then validated the risk score in an independent cohort of 69 participants from the University Hospital of Tours, Tours, France.
TAKEAWAY:
Overall, 232 (22.4%) participants had at least one positive result during drug provocation testing, whereas 803 (77.6%) did not react to the suspected culprit NSAIDs.
The CA4TCH tool had a sensitivity of 78.4%, specificity of 70.4%, and positive and negative predictive values of 43.3% and 91.9%, respectively.
Among participants with a negative result, the model successfully delabeled 565 of 803 cases (70.4%). In these cases, past symptoms commonly included angioedema, urticaria, or pruritus.
External validation showed comparable predictive performance.
IN PRACTICE:
'Given existing variation in testing protocols across clinical centers, the fact that the CA4TCH score is based on clinical history elements alone means it can be used to generate a prediction for any individual upon presentation and could thus constitute a practical tool to be used alongside or as part of existing phenotype classifications,' the authors of the study wrote.
SOURCE:
Ileana-Maria Ghiordanescu, MD, PhD, with the Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, was the corresponding author of the study, which was published online on July 16 in The Journal of Allergy and Clinical Immunology: In Practice.
LIMITATIONS:
Fixed drug eruptions were underrepresented in the study, and the researchers did not consider food allergy phenotypes because they lacked information about food sensitization.
DISCLOSURES:
Some authors reported receiving financial support, including grants, consulting fees, honoraria, or support for attending meetings, from institutions and pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.