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NSAIDNSAID-ASNCT07034066

Pediatric Non-Steroidal Anti-Inflammatory Drugs (NSAID) Allergy Study

An observational study of NSAID and Biomarkers, run by Fundació Sant Joan de Déu at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Non-steroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly used medications to treat pain and inflammation. Many are available over the counter and are frequently used in children to reduce fever and relieve pain. Read more about this study

Who is it for?
Ages 1 month to 17 years
Conditions the study is for
NSAID, Biomarkers, Phenotyping
How many people
257 participants
Where
1 siteSpain
Study dates
15 Mar 2022to 1 May 2025
How long will I take part?
11 Years
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 month to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Study population: The study population consists of pediatric patients (aged 0 to 17 years) with a clinical suspicion or confirmed diagnosis of hypersensitivity NSAID. Retrospective Cohort: Includes all patients who underwent at least one drug provocation test (DPT) for suspected NSAID hypersensitivity between January 2014 and December 2021 at the Pediatric Allergy Department of Hospital Sant Joan de Déu. Prospective Cohort: Includes newly referred patients to the outpatient Pediatric Allergy Clinic from August 2022 to December 2024, presenting with clinical symptoms suggestive of NSAID hypersensitivity. Eligibility is determined based on: * Clinical manifestations (cutaneous and/or respiratory) following NSAID intake. * A high likelihood of an adverse drug reaction based on history. * Informed consent signed by parents or legal guardians. * Patients with incomplete DPTs or those whose guardians decline consent (for the prospective arm) are excluded.

Who may be able to join

  • Children aged 0-17 years
  • Completed DPT with the suspected and/or alternative NSAID

Who cannot join

  • Patients who did not undergo or complete the DPT

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Hospital Sant Joan de Deu

    Esplugues de Llobregat, Barcelona, 08950

Other trials in Spain

About this study

Official title: Study of Hypersensitivity to Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in Pediatric Population

Non-steroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly used medications to treat pain and inflammation. Many are available over the counter and are frequently used in children to reduce fever and relieve pain. Hypersensitivity (HS) to NSAIDs affects an estimated 0.6% to 5.7% of the general population. These reactions can be caused by immune or non-immune mechanisms. In most cases, they fall into two categories: reactions to a single NSAID or to several different NSAIDs.

Currently, the main way to diagnose NSAID hypersensitivity is through a drug provocation test (DPT)-this involves giving the patient the suspected drug under medical supervision to check for a reaction. It's considered the most reliable method. However, diagnosing these reactions in children can be challenging. Symptoms can vary widely, and there are few accurate alternative tests available to replace the DPT.

This study looks for easier ways-like symptoms or lab tests-to diagnose NSAID reactions, so fewer patients need to go through multiple DPT.

Read the detailed description

Hypersensitivity reactions (HSR) to NSAID in children, although similar to those in adults, present unique challenges in terms of diagnosis and management. While international classification systems are useful, real-world clinical scenarios often fall outside established criteria. Examples include:

  • Multiple NSAID HSR involving both cutaneous and respiratory symptoms.
  • NSAID-induced anaphylaxis dependent on food intake.
  • Immediate selective reactions to more than one NSAID. These scenarios are frequently observed in pediatric patients, highlighting the need for a regional study to evaluate and properly address them.

This is a single-center, ambispective observational study.

Primary Objective:

To describe the clinical characteristics of children with NSAID hypersensitivity.

Secondary Objectives:

  1. To describe the different clinical phenotypes and assess age-related differences.
  2. To assess tolerance to alternative NSAIDs in patients with confirmed hypersensitivity.
  3. To evaluate the usefulness of in vivo and in vitro tests in the diagnostic process.
  4. To disseminate study findings.

The study design is based on 2 components:

  • Retrospective Component: include participants diagnosed with NSAID HSR, who underwent DPT in the Pediatric Allergy Department at Hospital Sant Joan de Déu between January 2014 and December 2021. Data will be pseudonymized. A waiver of informed consent will be requested due to the long study period, the absence of risk, and the fact that many patients are no longer under follow-up.
  • Prospective Component: participants with suspected NSAID HSR were included. Participants will be assessed during outpatient visits, where the following steps will occur:
  • In vivo testing, where appropriate, using validated prick and intradermal techniques for paracetamol and metamizole. Controls will include saline (negative) and histamine (positive).
  • A DPT will be performed with the suspected medication and/or suitable alternatives, in accordance with standard clinical practice.
  • Nasal DPT using a rhinomanometer for patients suspected of NSAID-exacerbated respiratory disease (NERD).
  • Families will be informed about the procedures, and informed consent will be obtained.

On the day of the DPT, a blood test (including total IgE, IgG, IgA, IgM, tryptase, IL-6) and urine sample (uLTE4 levels) will be collected.

If the DPT is positive, a second round of blood and urine samples will be collected.

The NSAID to be used in testing are commonly prescribed in pediatric practice and grouped by chemical structure:

Salicylic acid derivatives: Aspirin Para-aminophenol derivatives: Paracetamol (acetaminophen) Propionic acid derivatives: Ibuprofen, naproxen Acetic acid derivatives: Diclofenac Enolic acid derivatives: Pyrazolones, oxicams Fenamates (fenamic acid derivatives) COX-2 inhibitors: Celecoxib

Keywords
NSAID-hipersensitivity in children, children drug allergy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT07034066
Study groupRoleWhat they receive
Prospective CohortIncludes new patients referred to the Pediatric Allergy outpatient clinic with suspected NSAID hypersensitivity. Inclusion Criteria: Children aged 0-17 years Clinical suspicion of NSAID hypersensitivity Exclusion Criteria: Refusal to provide informed consent At the first outpatient visit: A complete medical history and physical exam will be performed The need for DPT (oral/nasal) will be explained to the family Informed consent will be obtained On admission for oral DPT: blood and urine samples will be collected DPT will be conducted via oral route unless the original reaction occurred after intravenous administration Positive DPTs will be followed by sample collection and symptom management A follow-up phone call will be made within 6 months to assess home tolerance For patients undergoing nasal DPT, the test will be conducted in the hospital's ENT unit, and follow-up will depend on the result.
Retrospective CohortIncludes all patients who underwent a DPT for NSAID hypersensitivity between 2014 and 2021 in the Pediatric Allergy Unit. Inclusion Criteria: Children aged 0-17 years Completed DPT with the suspected and/or alternative NSAID Exclusion Criteria: Patients who did not undergo or complete the DPT Upon protocol approval, data on all hospital admissions related to NSAID hypersensitivity evaluation (2014-2021) will be requested. Clinical records will be reviewed after pseudonymization, which will be performed by an independent individual, Ms. Silvia del Valle, who will also safeguard the pseudonymization key. This complies with legal requirements for accessing medical records without consent, under CEIm approval, including: Functional and technical separation between investigators and data processors Explicit confidentiality and non-reidentification commitment

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Clinical characteristics of pediatric patients with NSAID hypersensitivity, based on historical data and development of a diagnostic protocol.

    In both the retrospective and prospective arm, the investigators reviewed the medical records of patients who completed DPT. Participant demographic data were reviewed, including age, sex, personal and family history of atopy, and the results of DPTs performed on suspected medications and alternatives if necessary.

    Final phenotypes after DPT were:

    • Cross-intolerance (CI)
    • Selective hypersensitivity (SH)

    Measured: Retrospective arm: review of the medical records took about 4-6 months Prospective arm: from enrollment to DPT, 6-8 months.

Secondary outcomes (3)
  1. Differences in clinical features across different pediatric age groups.

    In both the retrospective and prospective groups, factors that may predispose to having a confirmed HS based on the clinical history will be analyzed: sex, age, history of atopy, angioedema, rash/urticaria, reason for which the drug is prescribed, having presented more than 1 reaction with the same drug or different NSAIDs.

    Measured: Retrospective arm: review of the medical records took about 4-6 months Prospective arm: from enrollment to DPT, 6-8 months.

  2. Rate of tolerance to alternative NSAIDs among patients with confirmed hypersensitivity.

    In the retrospective arm, in participants with cross-intolerance, all tolerated high-dose paracetamol and COX-2 inhibitors (meloxicam). Those with selective NSAID HS were tested for tolerance to alternatives from other groups as appropriate.

    In the prospective arm, the investigators do not yet have results.

    Measured: Retrospective arm: review of the medical records took about 4-6 months Prospective arm: from enrollment to DPT, 6-8 months.

  3. Diagnostic performance of in vivo and in vitro tests.

    Both in vivo and in vitro testing were performed in the prospective arm, and DPT is still pending, so the investigators are waiting to complete this in order to analyze the results.

    Measured: Prospective arm: from enrollment to DPT, 6-8 months.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Jun 2025
  2. Study start15 Mar 2022
  3. Primary completion30 Dec 2024
  4. Study completion1 May 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Other
Enrolment
257 participants (actual)
Target duration
11 Years
IDs, dates and publications
ClinicalTrials.gov ID
NCT07034066
Sponsor's protocol ID
Sant Joan de Deu Foundation
Acronym
NSAID-AS
Status last verified
May 2025
First submitted
29 May 2025
Last updated
24 Jun 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Data will be available beginning 6 months after publication and will remain accessible for 5 years. The results will be available in clinicaltrials.gov with supporting information (Clinical Study Report (CSR)).

Publications

  • Klaewsongkram J, Buranapraditkun S, Mongkolpathumrat P, Palapinyo S, Chantaphakul H. Clinical Characteristics, Urinary Leukotriene E4 Levels, and Aspirin Desensitization Results in Patients With NSAID-Induced Blended Reactions. Allergy Asthma Immunol Res. 2021 Mar;13(2):229-244. doi: 10.4168/aair.2021.13.2.229.

    PubMed 33474858
  • Dona I, Saenz de Santa Maria R, Moreno EM, Bartra J, Torres MJ. An algorithm for the diagnosis and treatment of nonsteroidal antiinflammatory drugs hypersensitivity, 2024 update. Allergy. 2025 Apr;80(4):1183-1186. doi: 10.1111/all.16349. Epub 2024 Oct 4. No abstract available.

    PubMed 39365158
  • Blanca-Lopez N, Haroun-Diaz E, Ruano FJ, Perez-Alzate D, Somoza ML, Vazquez de la Torre Gaspar M, Rivas-Ruiz F, Garcia-Martin E, Blanca M, Canto G. Acetyl Salicylic Acid Challenge in Children with Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs Differentiates Between Cross-Intolerant and Selective Responders. J Allergy Clin Immunol Pract. 2018 Jul-Aug;6(4):1226-1235. doi: 10.1016/j.jaip.2017.08.029. Epub 2017 Oct 3.

    PubMed 28986120
  • Cavkaytar O, Arga M. NSAID Hypersensitivity in the Pediatric Population: Classification and Diagnostic Strategies. J Asthma Allergy. 2022 Sep 28;15:1383-1399. doi: 10.2147/JAA.S267005. eCollection 2022.

    PubMed 36199560
  • Kidon M, Blanca-Lopez N, Gomes E, Terreehorst I, Tanno L, Ponvert C, Chin CW, Caubet JC, Soyer O, Mori F, Blanca M, Atanaskovic-Markovic M. EAACI/ENDA Position Paper: Diagnosis and management of hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) in children and adolescents. Pediatr Allergy Immunol. 2018 Aug;29(5):469-480. doi: 10.1111/pai.12915. Epub 2018 Jun 13.

    PubMed 29693290

Questions about this trial

What is this clinical trial studying?

An observational study of NSAID and Biomarkers, run by Fundació Sant Joan de Déu at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 24 Jun 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinical characteristics of pediatric patients with NSAID hypersensitivity, based on historical data and development of a diagnostic protocol. (time frame: Retrospective arm: review of the medical records took about 4-6 months Prospective arm: from enrollment to DPT, 6-8 months.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07034066, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Jun 2025.

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