Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Pediatric Drugs
Published in: Pediatric Drugs 5/2004

01-09-2004 | Current Opinion

Ibuprofen and Increased Morbidity in Children with Asthma

Fact or Fiction?

Authors: Dr Ralph E. Kauffman, Mary Lieh-Lai

Published in: Pediatric Drugs | Issue 5/2004

Login to get access

Abstract

NSAIDs are commonly avoided by patients with aspirin-induced asthma based on the premise that there is a significant cross-reactivity between aspirin and other NSAIDs. However, ibuprofen, a NSAID sold over the counter in most countries, is commonly given to children for relief of fever and mild-to-moderate pain. Consequently, increased risk of acute bronchospasm induced by ibuprofen in children with asthma remains a persistent concern.
More recently, the assumption that children with asthma are at a greater risk for exacerbations of their disease if they take ibuprofen has been questioned. There is little evidence to suggest that ibuprofen measurably increases morbidity in the great majority of children with asthma.
Given the infrequent occurrence of aspirin/NSAID sensitivity in children with asthma, it seems reasonable to allow the use of ibuprofen in this population unless there is a personal or family history of aspirin-induced asthma. In addition, the inflammatory pathogenesis of asthma, anti-inflammatory effect of ibuprofen, and evidence suggesting ibuprofen may reduce morbidity in children with asthma raises the intriguing possibility that ibuprofen might actually have therapeutic benefit for at least some children with asthma.
Literature
1.
Szczeklik A, Gryglewski RJ. Asthma and anti-inflammatory drugs: mechanisms and clinical patterns. Drugs 1983; 25: 533–43PubMedCrossRef
2.
McNeil Consumer & Specialty Pharmaceuticals. Motrin® [package insert]. Washington (PA): McNeil Consumer & Specialty Pharmaceuticals, 1994
3.
Roche Pharmaceuticals. Naprosyn® [package insert]. Nutley (NJ): Roche Pharmaceuticals, 2001
4.
Merck & Co., Inc. Dolobid® [package insert]. West Point (PA): Merck & Co., Inc., 1998
5.
Hurwitz ES, Barrett MJ, Bregman D, et al. Public Health Service study of Reye’s syndrome and medications: report of the main study. JAMA 1987; 257(14): 1905–11PubMedCrossRef
6.
Anonymous. More to the management of aspirin-induced asthma than just avoiding aspirin. Drugs Therapy Perspect 2000; 16(5): 5–7
7.
8.
Lesko SM, Louik C, Vezina RM, et al. Asthma morbidity after short-term use of ibuprofen in children. Pediatrics 2002; 109(2): 1–4CrossRef
9.
Bacharier LB, Jabara H, Geha RS. Molecular mechanisms of immunoglobulin E regulation. Int Arch Allergy Immunol 1998; 115: 257–69PubMedCrossRef
10.
Siraganian RP. Biochemical events in basophil or mast cell activation and mediator release. In: Middleton Jr E, Reed CR, Ellis EF, et al., editors. Allergy: principles and practice. 5th ed. Vol. 1. St. Louis (MO): Mosby Year Book, 1998: 204–27
11.
Burd PR, Rogers HW, Gordon JR, et al. Interleukin 3-dependent and -independent mast cells stimulated with IgE and antigen express multiple cytokines. J Exp Med 1989; 170: 245–57PubMedCrossRef
12.
Brown MA, Pierce JH, Watson CJ, et al. B cell stimulatory factor-1/interleukin-4 mRNA is expressed by normal and transformed mast cells. Cell 1987; 50: 809–18PubMedCrossRef
13.
Sanderson CJ, Campbell HD, Young IG. Molecular and cellular biology of eosinophil differentiates factor (interleukin-5) and its effects on human and mouse B cells. Immunol Rev 1988; 102: 27–50CrossRef
14.
Ohkawara Y, Lei CF, Stampfli R, et al. Cytokine and eosinophil responses in the lung, peripheral blood, and bone marrow compartments in a murine model of allergen-induced airways inflammation. Am J Respir Cell Mol Biol 1997; 16: 510–20PubMed
15.
Lefort J, Nahori MA, Ruffie C, et al. In vivo neutralization of eosinophil-derived major basic protein inhibits antigen-induced bronchial hyperreactivity in sensitized guinea pigs. J Clin Invest 1996; 97: 1117–21PubMedCrossRef
16.
17.
18.
19.
Matricardi PM, Rosmini F, Ferrigno L, et al. Cross-sectional retrospective study of prevalence of atopy among Italian military students with antibodies against hepatitis A virus. BMJ 1997; 314: 999–1003PubMedCrossRef
20.
Ball TM, Castro-Rodriguez JA, Griffith KA, et al. Siblings, day-care attendance, and the risk of asthma and wheezing during childhood. N Engl J Med 2000; 343: 538–43PubMedCrossRef
21.
Sporik R, Holgate ST, Platts-Mills TA, et al. Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood: a prospective study. N Engl J Med 1990; 323: 502–7PubMedCrossRef
22.
Rosentreich DL, Eggleston P, Kattan M, et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner city children with asthma. N Engl J Med 1997; 336: 1356–63CrossRef
23.
Sporik R, Squillace SP, Ingram JM, et al. Mite, cat and cockroach exposure, allergen sensitization and asthma in children: a case control study of three schools. Thorax 1999; 54: 675–80PubMedCrossRef
24.
Widal MG, Abrami P, Lenmoyez J. Anaphylaxie et idiosyncrasie. Presse Med 1922; 30: 189–92
25.
Sonneville A. Current synthetic notions on aspirin induced asthma. Biomed Pharmacother 1999; 53: 312–4PubMedCrossRef
26.
Falliers CJ. Aspirin and subtypes of asthma: risk factor analysis. J Allergy Clin Immunol 1973; 52: 141–7PubMedCrossRef
27.
Estrada Rodriguez JL, Florido Lopez JF, Belchi Hernandez J, et al. Asthma in children and ASA intolerance. J Invest Allergol Clin Immunol 1993; 3: 315–20
28.
Szczeklik A, Gryglewski RJ, Czerniawska-Mysic G. Relationship of inhibition of prostaglandin biosynthesis by analgesics to asthma attacks in aspirin-sensitive patients. BMJ 1975; 1: 67–9PubMedCrossRef
29.
O’Sullivan S, Dahlen B, Dahlen SE, et al. Increased urinary excretion of the prostaglandin D2 metabolite 9α, 11β-prostaglandin F2 after aspirin challenge supports mast cell activation in aspirin-induced airway obstruction. J Allergy Clin Immunol 1996; 98: 421–32PubMedCrossRef
30.
Christie PE, Tagari P, Ford-Hutchinson AW, et al. Urinary leukotriene E4 concentrations increase after aspirin challenge in aspirin-sensitive asthmatic subjects. Am Rev Respir Dis 1991; 143: 1025–9PubMed
31.
Knapp HR, Sladek K, Fitzgerald GA. Increased excretion of leukotriene E4 during aspirin-induced asthma. J Lab Clin Med 1992; 119: 48–51PubMed
32.
Penrose JF, Spector J, Baldasaro M, et al. Molecular cloning of the gene for human leukotriene C4 synthase: organization, nucleotide sequence, and chromosomal localization to 5q35. J Biol Chem 1996; 271: 11356–61PubMedCrossRef
33.
Leff AR. Regulation of leukotrienes in the management of asthma: biology and clinical therapy. Annu Rev Med 2002; 52: 1–14CrossRef
34.
Dahlen B, Nizankowska E, Szczeklik A, et al. Benefits from adding the 5-lipoxygenase inhibitor zileuton to conventional therapy in aspirin-intolerant asthmatics. Am J Respir Crit Care Med 1998; 157: 1187–94PubMed
35.
Setipane RA, Schrank PJ, Simon RA, et al. Prevalence of cross-sensitivity with acetaminophen in aspirin-sensitive asthmatic subjects. J Allergy Clin Immunol 1995; 96: 480–5CrossRef
36.
Klein JS, Hunt LW. Drug-induced asthma: immunological mechanisms and practical implications. Clin Immunother 1994; 1: 181–90CrossRef
37.
38.
Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis and management. J Allergy Clin Immunol 1999; 104: 5–13PubMedCrossRef
39.
Settipane RA, Stevenson DD. Cross sensitivity with acetaminophen in aspirin-sensitive subjects with asthma. J Allergy Clin Immunol 1989; 84: 26–32PubMedCrossRef
40.
Stevenson DD, Simon RA. Lack of cross-reactivity between rofecoxib and aspirin in aspirin-sensitive patients with asthma. J Allergy Clin Immunol 2001; 108: 47–51PubMedCrossRef
41.
Goraya JS, Virdi VS. Exacerbation of asthma by ibuprofen in a very young child [letter]. Pediatr Pulmonol 2001; 32: 262PubMedCrossRef
42.
Menendez R, Venzor J, Ortiz G. Failure of zafirlukast to prevent ibuprofen-induced anaphylaxis. Ann Allergy Asthma Immunol 1998; 80: 225–6PubMedCrossRef
43.
44.
Konstan MW, Byard PJ, Hoppel CL, et al. Effect of high-dose ibuprofen in patients with cystic fibrosis. N Engl J Med 1995; 332: 848–54PubMedCrossRef
45.
Khan TZ, Wagener JS, Bost T, et al. Early pulmonary inflammation in infants with cystic fibrosis. Am J Respir Crit Care Med 1995; 151: 1075–82PubMed
46.
Frangova V, Sacco O, Silvestri M. BAL neutrophilia in asthmatic patients: a byproduct of eosinophil recruitment? Chest 1996; 110: 1236–42PubMedCrossRef
47.
Szczeklik A, Gryglewski RJ, Nizankowska E. Asthma relieved by aspirin and by other cyclo-oxygenase inhibitors. Thorax 1978; 33: 664–5PubMedCrossRef
48.
Kordansky D, Adkinson NF, Norman PS, et al. Asthma improved by nonsteroidal anti-inflammatory drugs. Ann Intern Med 1978; 88: 508–11PubMed
49.
Resta O, Foschino-Barbaro MP, Carnimeo N, et al. Asthma relieved by acetylsalicylic acid and nonsteroid anti-inflammatory drugs. Respiration 1984; 46: 121–7PubMedCrossRef
50.
Phillips GD. The effect of oral terfenadine alone or in combination with flurbiprofen on the bronchoconstrictor response to inhaled adenosine 5′-monophosphate in nonatopic asthma. Am Rev Respir Dis 1989; 139: 463–9PubMedCrossRef
51.
Finnerty JP, Holgate ST. Evidence for the roles of histamine and prostaglandins as mediators in exercise-induced asthma: the inhibitory effect of terfenadine and flurbiprofen alone and in combination. Eur Respir J 1990; 3: 540–7PubMed
52.
Bianco S, Pieroni MG, Refini RM, et al. Could NSAIDs have a role as antiasthmatic agents? Drugs 1994; 48: 9–15PubMedCrossRef
53.
Glibetic M, Samlalsingh-Parker J, Raykova V, et al. Group B streptococci and inducible nitric oxide synthase: modulation by nuclear factor kappa B and ibuprofen. Semin Perinatol 2001; 25: 65–9PubMedCrossRef
Metadata
Title
Ibuprofen and Increased Morbidity in Children with Asthma
Fact or Fiction?
Authors
Dr Ralph E. Kauffman
Mary Lieh-Lai
Publication date
01-09-2004
Publisher
Springer International Publishing
Published in
Pediatric Drugs / Issue 5/2004
Print ISSN: 1174-5878
Electronic ISSN: 1179-2019
DOI
https://doi.org/10.2165/00148581-200406050-00001