Les réactions d'hypersensibilité allergique et non allergique aux antalgiques non opiacés, antipyrétiques et anti-inflammatoires non stéroïdiens chez l'enfant : épidémiologie, aspects cliniques, physiopathologie, diagnostic et prévention § Allergic and non-allergic hypersensitivity to non-opioid analgesics, antipyretics and nonsteroidal anti- inflammatory drugs in children: Epidemiology, clinical aspects, pathophysiology, diagnosis and prevention

AbstractNon-opioid analgesics,antipyreticsandnonsteroidalanti-inammatorydrugsare widelyused,but suspectedallergicreactions tothesedrugsarerare,especiallyinchildren.Mostfrequentreactionsarecutaneous(urticaria,angioedema)andrespiratory (rhinitis,asthma).Otherreactions(anaphylaxis,potentiallyharmfultoxidermias)arerare.Inafewpatients,reactions mayresultfroma specic(allergic)hypersensitivity,withpositiveresponsesin prickandintradermaltests(anaphylaxis, immediateurticariaand/orangioedema)andin intradermalandpatchtests(non-immediatereactions).However, mostreactionsresultfromanon-specic(non-allergic)hypersensitivity(intolerance),withafrequentcross-reactivity betweenthe variousfamiliesof analgesics,antipyreticsandnonsteroidalanti-inammatorydrugs,includingparacetamol. Basedonaconvincingclinicalhistoryand/orpositiveresponsesinchallengetests,intolerancetonon-opioidanalgesics, antipyreticsandnonsteroidalanti-inammatorydrugshasbeendiagnosedin13 to 50%ofthepatientswithallergic-like reactionsto thesedrugs.Riskfactorsareapersonalatopyandage.Preventionisbasedonadministrationofother (familiesof)analgesics,antipyreticsandnonsteroidalanti-inammatorydrugsinpatientswithallergichypersensitivityto thesedrugs.Inpatientswithnon-allergichypersensitivity,preventionisbasedonadministrationofdrugswithalowcyclo-oxygenase-1 inhibitoryactivity(iftolerated).Desensitizationisefcientinpatientswithrespiratoryreactions,butdoes notworkinpatientswithmucocutaneousreactionsandanaphylaxis. 2012ElsevierMassonSAS.Allrightsreserved.