How Can We Better Classify NSAID Hypersensitivity Reactions? – Validation from a Large Database

Abstract

Background: Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) is one of the most common drug hypersensitivities. Several clinical subtypes have been distinguished depending on symptomatology (respiratory, cutaneous, anaphylaxis), timing (immediate, delayed), underlying chronic disease (asthma, chronic urticaria) or putative mechanism of the reaction (allergic, nonallergic mediated). The aim of the present study was to better classify the many hypersensitivity reactions to NSAIDs. Methods: In the present retrospective study, duringan 11-year study period, we collected data from all patients with a proven NSAID hypersensitivity. Reactions were classified according to clinical patterns, chronology, underlying diseases and the results of oral provocation tests into 5 and 7 groups in line with two published classifications, respectively. Results: Forty-nine and 88 out of 307 reactions (in 122 patients) could not be classified on the basis of the two previously published classifications. We created a new classification which could include all patient reactions. Conclusions: Our new classification is more suitable for clinical expression of NSAID hypersensitivity. It allows clinicians to identify patients at a high risk, based on the clinical history and clinical manifestations. Moreover, it is helpful for a better understanding and teaching of these reactions.

Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs among Adults: Clinical Features and Risk Factors for Diagnosis Confirmation

“…Research has shown that up to 40% of NSAID HS reactions are selective [12,13,20,34,35,41], and our results are in line with this findings.…”

“…Sánchez-Borges et al [13 ](40%), Caimmi et al [20 ](39%), and Nissen et al [30 ](40%)[.] However, some studies indicate that, nowadays, acetylsalicylic acid is not the most common drug involved in HS, and they refer to propionic acid derivatives, i.e.…”

“…Different classification of reactions to NSAIDs and phenotypes have been described over the last decades based on clinical presentation, culprit drugs, onset of reactions and preexisting respiratory or cutaneous diseases [11,17,18,19,20,21]. An updated classification of reactions was published in a consensus paper by the European Academy of Allergy and Clinical Immunology (EAACI) in 2013 [22], and we adopted it in this work.…”

Multiple Nonsteroidal Anti-Inflammatory Drug-Induced Cutaneous Disease: What Differentiates Patients with and without Underlying Chronic Spontaneous Urticaria?

“…Some studies have shown a possible specific genetic profile in patients with both chronic urticaria and NSAID hypersensitivity [25,26,27]; it would be interesting to establish whether otherwise normal multiple NSAID reactors also show the same profile. Recently, a new classification of NSAID hypersensitivity reactions has been suggested [1], and subsequent amendments have been proposed [28]. It is possible that in the light of the finding of this study, some further changes are needed.…”

Single Non-steroidal Anti-inflammatory Drug-Induced Hypersensitivity Reactions in Children: Case Report

“…Patients single NSAID induced reactions usually do not have an underlying chronic cutaneous or respiratory disease, but may have a history of hypersensitivity to food or other drugs. 7 In contrast to single NSAID induced reactions, a chronic respiratory disease (asthma/rhinosinusitis/nasal polip) or cutaneous disease (chronic spontaneous urticaria) exists in patients with NSAID-exacerbated respiratory disease or NSAIDsexacerbated cutaneous disease which are both cross-reactive type of NSAID hypersensitivities. Case 2 and Case 3 are noteworthy for their underlying chronic diseases but single NSAID induced reactions.…”