Characteristics and Contributing Factors Related to Nonsteroidal Anti-Inflammatory Drugs Hypersensitivity

Abstract

<b><i>Introduction:</i></b> Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) is reported to be the most common drug hypersensitivity. The aim of this study was to evaluate the characteristics of self-reported NSAID hypersensitivity and identify patients at high risk of NSAID hypersensitivity. <b><i>Methods:</i></b> Patients who presented at a single tertiary care hospital between January–December 2017 with reported NSAID hypersensitivity were evaluated. Clinical information obtained from a review of medical records was further supplemented with data gained from a telephone-administered questionnaire. <b><i>Results:</i></b> From a total of 535 patients with reported NSAID hypersensitivity, 301 were included in the study. The mean age of onset of NSAID hypersensitivity reaction was 30.3 ± 14.9 years old. A total of 84 patients (27.9%) were hypersensitive to 2 or more chemically unrelated NSAIDs. The leading NSAID hypersensitivity was to propionic acid derivatives (73%) followed by acetic acid derivatives (28.9%). Immediate reaction (≤1 h) was identified in 171 patients (57.8%), and angioedema was the most frequently reported symptom (179 patients, 59.5%), followed by urticaria and anaphylaxis in 85 (28.2%) and 62 (20.6%) patients, respectively. A drug provocation test was performed on 53 patients, and NSAID hypersensitivity was confirmed in 38 patients (71.6%). The independent factors identified, which could predict NSAID hypersensitivity, were personal history of allergic rhinitis/chronic rhinosinusitis (AR/CRS), onset of NSAID hypersensitivity over 15 years old, and immediate reaction. <b><i>Conclusion:</i></b> Angioedema was the most typical symptom, and propionic acid derivatives were the most frequently reported culprit drugs. The significant risk factors predicting NSAID hypersensitivity were personal history of AR/CRS, onset of NSAID hypersensitivity reaction over 15 years old, and immediate reaction.

Nonsteroidal anti‐inflammatory drug hypersensitivity in a pediatric severe asthmatic population

“…Previous general pediatric studies found that the most common symptoms were isolated skin involvement (urticaria, angioedema). 6 However, this study found that children with severe asthma were more likely to report respiratory symptoms with NSAID ingestion and cutaneous symptoms were relatively uncommon. The reason behind this difference is unknown but could be from underlying airway inflammation in those with severe asthma.…”

“…8 Previous studies reported that participants with NSAID-H (diagnosed by history or OPT) frequently had reactions to more than one NSAID, had a history of atopy, and reported rhinoconjunctivitis symptoms with ingestion. 6 Interestingly, this study identified several additional, novel associations with NSAID-H including allergy to medications that are not NSAIDs, nasal polyps, ageusia, asthma triggered by viral infection, and an immediate family member with sinusitis. A multivariate analysis found that nasal polyps are independently associated with NSAID use, further suggesting that a subset of children with severe asthma are developing NERD.…”

Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs: does age matter?

“…The data was processed using the R statistical software, version 4.2.0 (R Core Team, 2022) for Windows. A p-value of <0.05 was considered statistically significant [11].…”