Children with severe asthma may be more at risk for NSAID-exacerbated respiratory disease
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PHOENIX — Children with severe asthma appeared more likely to experience NSAID-exacerbated respiratory disease, according to a study presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
“We wanted to see how many of the kids in our high-risk asthma clinic at our pediatric hospital in Indianapolis reported an allergic reaction to one of several NSAID drugs,” Abigail Hadley, an MD candidate with a concentration in medical genetics at Indiana University School of Medicine, told Healio.
With an average age of 12 years (standard deviation, 4; range, 6-18), 79 patients (54% male; 66% Black) with severe asthma based on National Heart, Lung, and Blood Institute guidelines completed anonymous surveys during in-patient visits at Riley Hospital for Children between November 2020 and January 2022.
The survey asked about asthma triggers, allergies, comorbid diagnoses, sinus symptoms, NSAID reaction history and results of NSAID challenges when applicable.
Typically, 0.3% to 5% of pediatric populations experience NSAID-exacerbated respiratory disease (NERD), described as a triad of asthma, nasal polyps and NSAID sensitivity, the researchers said. However, 20% (n = 16) of the study participants reported at least one reaction to NSAID medication.
“The prevalence of it being so high was a surprise for us,” Hadley said.
The most common symptoms were dyspnea (50%), wheezing (42%), abdominal pain (42%), dizziness or lightheadedness (42%), runny nose (33%), coughing (33%) and congestion (25%). Children with NERD usually present different symptoms than adults, the researchers said.
Risk factors for NERD included nasal polyps (38% in those with reactions vs. 11% in nonreactors; P = .01), loss of sense of taste (25% vs. 5%; P = .03), laughter-triggered asthma (31% vs. 11%; P = .05), cold temperature-triggered asthma (81% vs. 48%; P = .02) and an immediate family member with sinusitis (44% vs. 16%; P = .02).
Ibuprofen was the most common trigger of symptoms, at 18% (n = 14), followed by aspirin and acetaminophen at 10% each (n = 8 for both).
“Then there was about 81% (n = 13) of those who reported that they had a reaction to more than one drug,” said Hadley.
These children took NSAIDs sparingly, not daily, usually in response to headache or fever.
“A lot of them would actually avoid NSAIDs because in their mind, they associated them with, ‘Oh, I have to grab my inhaler after I take this medication,’” Hadley said.
The researchers aim to continue the study and are looking for more participants. They also would like to reach out to the patients who reported symptoms to see if they would be interested in a diagnostic workup including an oral challenge or skin test that would confirm a diagnosis of NERD.
“That would be good to see. Of those reporting an anecdotal history of reactions, how many have a true reaction, and then of those, how many have the full-blown disease of NERD?” Hadley said. “That would be the ideal next step for this study.”
Two of these patients have had testing so far to confirm true hypersensitivity to NSAIDs, although Hadley said it may be difficult to follow-up with other patients.
“For families, the cost of drug testing is a deterrent, when they think that they can just avoid NSAIDs instead of paying for a drug test,” she said.
Still, Hadley emphasized that the prevalence of sensitivity to NSAIDs may be higher among children attending high-risk asthma clinics.
“It might be worth just asking families, ‘Have you ever had a reaction to this? Pay attention the next time you take this medication, because especially for kids with high-risk asthma, you really want to avoid everything that can give them an exacerbation,’” she said. “Give more powered information to families about what they can do to protect their child. That would be a great thing to know.”