Step doses for drug provocation tests to NSAIDs (ingestion challenges)

Hypersensitivity to non‐steroidal anti‐inflammatory drugs (NSAIDs) are of great concern because they are frequently encountered in daily clinical practice. Drug provocation tests (DPT) are particularly needed for NSAIDs.

This retrospective study from the University Hospital of Montpellier (France) evaluated eliciting dose thresholds during NSAIDs DPT. 311 positive DPT were analyzed.

The following steps for future DPT were suggested:

1. for the rapid absorption group (Acetylsalicylic acid, ibuprofen, ketoprofen, tiaprofenic acid), every 30 min: 20%‐30%‐50% of daily therapeutic dose

2. for the moderate absorption group, every 30 min: for diclofenac 5%‐15%‐30%‐50% and for celecoxib, 20%‐80%

3. for the slow absorption group, piroxicam, 25%‐75% separated by a 3h interval.

A surveillance period of 3h after the last dose is mandatory for patients.

DPT protocols for NSAID are empirical, driven by the knowledge on patterns of DHR, cross‐reactivity between NSAID and pharmacological effects of these all drugs.


Data‐driven step doses for drug provocation tests to non‐steroidal anti‐inflammatory drugs (NSAIDs), 2019.

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