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

Abstract

Background: Nonsteroidal anti-inflammatory drugs (NSAIDS) are among the most common causes of drug hypersensitivity (HS) reactions. The diagnosis is based on a careful clinical history, and provocation tests are considered the gold standard for diagnosis. Skin tests have some value to study reactions to pyrazolones. Laboratory investigations are mostly used for research purposes. Different phenotypes have been described. Objective and Methods: Our aim was to describe the most common clinical manifestations of NSAID HS in a large population of adult patients, the drugs involved, the association with previously described risk factors, and the outcome of diagnostic procedures. The classification of reactions proposed by the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group was adopted. Results: Acetylsalicylic acid was the drug most often involved in reactions (34%), isolated cutaneous symptoms were the most reported (60%), and immediate reactions (58%) were the most common. There was an overall female predominance (64%) and 35% of the patients were atopic. HS to NSAIDs was confirmed in 21% of the patients. The most common phenotypes encountered among HS patients were NSAID-induced urticaria/angioedema and single-NSAID-induced urticaria/angioedema or anaphylaxis. Logistic regression analysis showed that gender and atopy were not significant risk factors for HS confirmation, but diagnosis depended on the number of previous reactions, the type of reaction, and the time interval between drug intake and reaction. Conclusion: Only 21% of suspected HS reactions were confirmed after diagnostic workup. Patients describing >1 previous reaction and suffering immediate reactions had a higher probability of a positive investigation.

Characteristics of NSAID‐induced hypersensitivity reactions in childhood

“…Gender was not a predictive factor in childhood; on the other hand, gender and age were significant prognostic factors in adulthood, being women decreased the risk in multivariate logistic regression analysis and subjects older than 40 years had a lower risk of actual NSAID‐H . However in another study involving patients older than 18 years, gender and atopy were not risk factors while having immediate reaction and existence of more than one reaction to a NSAID in the history increased the likelihood of confirmed hypersensitivity to NSAIDs …”

Anaphylaxis triggers in a large tertiary care hospital in Qatar: a retrospective study

“…Although other studies showed no such significant association between atopy and anaphylaxis [39, 40], atopy was frequently visualized as a risk factor that might worsen the clinical outcome of anaphylaxis [8, 18, 19, 21, 24, 41–43]. However, several studies stated that anaphylaxis was common among patients with atopic diseases.…”

Use of Epinephrine in Patients with Drug-Induced Anaphylaxis: An Analysis of the Beijing Pharmacovigilance Database

“…The drug hypersensitivity diagnostic workup could increase sensitivity when determining the causative drug for anaphylaxis [39,40,41,42,43]. However, such information was not recorded in the BPD.…”