Characterization of Patients with Ibuprofen Hypersensitivity

Ibuprofen and Other Arylpropionics: The Relevance in Immediate Hypersensitivity Drug Reactions

BACKGROUND

Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), is the most frequent medication to be involved in hypersensitivity drug reactions (HDRs). Other analgesic/anti-inflammatory drugs in the arylpropionic group are also relevant, albeit to a lesser extent. Ibuprofen is widely consumed by people of all ages, both on medical prescription and over the counter; moreover, it is an organic contaminant of surface waters and foods. While numerous drugs cause HDR, ibuprofen's underlying mechanisms are more intricate and involve both specific immunological and non-immunological mediated reactions.

SUMMARY

we concentrate on immediate responses, including urticaria with or without angioedema, anaphylaxis, and angioedema, classifying reactions according to whether they are caused by single or multiple NSAIDs and based on the mechanisms at play. Both groups may experience anaphylaxis, defined as an immediate, severe systemic reaction involving at least two organs, though the frequency and severity can vary. Following this classification, more clinical manifestations can be identified. Diagnosis is partly based on a detailed clinical history, including information about ibuprofen and/or other arylpropionic derivatives involved, the interval between drug intake and symptoms onset, clinical manifestations, number of episodes, and the patient's tolerance or response to other medications - mainly non-chemically related NSAID - both before and after reactions to ibuprofen and/or other arylpropionic drugs. A drug provocation test is frequently necessary to make a diagnosis.

KEY MESSAGE

Because ibuprofen is the most widely prescribed NSAID, it is reasonable to assume its role as the leading cause of HDR will only become more important.

Orbital compartment syndrome due to periorbital angioedema

A 68-year-old female presented with an episode of unilateral orbital compartment syndrome due to periorbital angioedema. The patient made a consultation at the general Emergency Room with sudden left periorbital edema and serious diminished ipsilateral visual acuity, with examination detecting orbital compartment syndrome secondary to a probable allergic angioedema after ingestion of ibuprofen. She received treatment with intravenous and oral corticosteroids, achieving a rapid improvement in the condition and clinical follow-up was carried out, with evaluation of the peripapillary retinal nerve fiber layer thickness and computed perimetry. Periorbital angioedema due to ibuprofen can be a cause of orbital compartment syndrome whose diagnosis and treatment must be carried out urgently to prevent permanent visual impairment.

Ibuprofen-induced Anaphylactic Shock in Adult Saudi Patient

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most prescribed medications globally. They act through inhibiting cyclooxygenase (COX)-1 and COX-2 enzymes. In contrast to other NSAIDs, anaphylaxis due to ibuprofen is quite rare, especially in adults. The management of anaphylaxis depends on early recognition of the symptoms, administering epinephrine, and avoidance of the causing allergen. Here, we report a case of a 23-year-old female who presented with anaphylactic shock after ingesting ibuprofen.