Natural evolution in patients with nonsteroidal anti‐inflammatory drug‐induced urticaria/angioedema

Doña, Inmaculada; Barrionuevo, Esther; Salas, María; Cornejo-García, J.A.; Perkins, James R.; Bogas, Gádor; Prieto, Ana; Torres, Marı́a José

doi:10.1111/all.13147

Cited by 43 publications

(37 citation statements)

References 34 publications

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“…118 More than 60% of NIUA patients tolerated NSAIDs within 6 years after their last reaction. 119 should be re-evaluated 6 years after the initial diagnosis, or even after a shorter interval in nonatopics (4-5 years), in those experiencing reactions more than 1 hour after NSAIDs intake and in those developing isolated urticaria. Such re-evaluation is crucial considering the large number of patients who could be avoiding NSAIDs despite being no longer hypersensitive 119,120 as occurs with other drugs.…”

Section: Niuamentioning

confidence: 99%

Progress in understanding hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs

Doña

Pérez‐Sánchez

Eguiluz‐Gracia

et al. 2019

Allergy

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Nonsteroidal anti‐inflammatory drugs (NSAIDs), the medications most commonly used for treating pain and inflammation, are the main triggers of drug hypersensitivity reactions. The latest classification of NSAIDs hypersensitivity by the European Academy of Allergy and Clinical Immunology (EAACI) differentiates between cross‐hypersensitivity reactions (CRs), associated with COX‐1 inhibition, and selective reactions, associated with immunological mechanisms. Three phenotypes fill into the first group: NSAIDs‐exacerbated respiratory disease, NSAIDs‐exacerbated cutaneous disease and NSAIDs‐induced urticaria/angioedema. Two phenotypes fill into the second one: single‐NSAID‐induced urticaria/angioedema/anaphylaxis and single‐NSAID‐induced delayed reactions. Diagnosis of NSAIDs hypersensitivity is hampered by different factors, including the lack of validated in vitro biomarkers and the uselessness of skin tests. The advances achieved over recent years recommend a re‐evaluation of the EAACI classification, as it does not consider other phenotypes such as blended reactions (coexistence of cutaneous and respiratory symptoms) or food‐dependent NSAID‐induced anaphylaxis. In addition, it does not regard the natural evolution of phenotypes and their potential interconversion, the development of tolerance over time or the role of atopy. Here, we address these topics. A state of the art on the underlying mechanisms and on the approaches for biomarkers discovery is also provided, including genetic studies and available information on transcriptomics and metabolomics.

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Section: Niuamentioning

confidence: 99%

Progress in understanding hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs

Doña

Pérez‐Sánchez

Eguiluz‐Gracia

et al. 2019

Allergy

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“…This mislabelling could be due to the fact that some symptoms (gastrointestinal or headache) are falsely considered as allergic, the virus and antibiotic interaction or the underlying infection itself can lead to cutaneous reactions, the low sensitivity of skin testing (STs) and the natural history with spontaneous resolution over time . This has been shown to be up to 63.15% in NSAID‐induced urticaria . Moreover, the incidence of repeated anaphylaxis after a perioperative‐allergy assessment was only 4% …”

Section: Mislabelling Influences Dhr Real Incidencementioning

confidence: 99%

“…48 This has been shown to be up to 63.15% in NSAID-induced urticaria. 49 Moreover, the incidence of repeated anaphylaxis after a perioperative-allergy assessment was only 4%. 50 This mislabelling is highly influenced by the over-reporting of allergies that happen in 8.3%, being higher in female, adults and inpatients 51 with BLs, NSAIDs and anaesthetics.…”

Section: Mis L Ab Elling Influen Ce S Dhr Re Al In Ciden Cementioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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“…Moreover, patients might have a trigger dose for reaction higher than 81 mg [11, 35] and an ENDA-EAACI expert panel suggests reaching a cumulative ASA dose between 75 and 150 mg [23]. To our knowledge, none of the previous studies on ASA administration in patients with ischemic heart disease and NSAID hypersensitivity have tried to compare between patients with a confirmed or nonconfirmed prior diagnosis of NSAID hypersensitivity [12-24].…”

Section: Discussionmentioning

confidence: 99%

“…We have described 13 patients with a confirmed and 10 with a nonconfirmed diagnosis to NSAID hypersensitivity who received the required dose of ASA from cardiology staff. However, we are not sure that this dose was enough to induce desensitization as it is lower than the dose needed to trigger a reaction in a significant number of NSAID-hypersensitive patients [35]. This has been discussed extensively and remains a controversial issue.…”

Section: Discussionmentioning

confidence: 99%

Establishing a Safe Administration of ASA in Cardiovascular Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity with Skin and/or Respiratory Involvement

Al‐Ahmad

Rodriguez-Bouza

Nurkic

2018

Int Arch Allergy Immunol

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Background: A history of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity with cross-intolerance to several drugs is common in some patients with coronary artery disease. We present a series of patients with acute coronary syndrome undergoing ASA desensitization prior to a possible stent to evaluate the short- and long-term efficacy and safety. The aim was to evaluate the outcomes of an ASA desensitization protocol developed by our center based on the guidelines proposed by the EAACI drug allergy expert recommendations. Methods: We developed a desensitization protocol that was based on both the patient characteristics and onset of reaction after NSAIDs, including premedication with a leukotriene antagonist and the H1-antagonist antihistamine. The clinical entities were NSAID-induced urticaria and/or angioedema in the absence of chronic spontaneous urticaria (NIUA) and NSAID-exacerbated respiratory disease (NERD). Results: A total of 23 patients were challenged or desensitized with ASA: 19 NIUA and 4 NERD. All patients tolerated the protocol at the different times of 30, 45, 90, and 120 min. The dosages of oral ASA that were given included 10, 21, 41, 81, and 162 mg (cumulative dose 315 mg). One patient reacted during the procedure and 1 during follow-up. Symptoms were limited to the skin without manifestations in other organs. All patients tolerated the required dose of ASA within 30–120 min. Those requiring urgent catheterization were desensitized within 90 min. Conclusions: Our protocol addresses challenge or desensitization with the contribution of a specialist allergist. It provides an effective, dynamic, safe, and short administration of 81 mg or higher of ASA in patients with a history of NSAID hypersensitivity with skin involvement.

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Natural evolution in patients with nonsteroidal anti‐inflammatory drug‐induced urticaria/angioedema

Abstract: NIUA patients may develop tolerance to NSAIDs over time, a process that seems to be influenced by atopy and type of clinical reaction.

Cited by 43 publications

References 34 publications

Progress in understanding hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs

Progress in understanding hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs

Recent developments and highlights in drug hypersensitivity

Establishing a Safe Administration of ASA in Cardiovascular Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity with Skin and/or Respiratory Involvement

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