Safety risks for patients with aspirin-exacerbated respiratory disease after acute exposure to selective nonsteroidal anti-inflammatory drugs and COX-2 inhibitors: Meta-analysis of controlled clinical trials

Moralès, Daniel; Lipworth, Brian J.; Guthrie, Bruce; Jackson, Catherine; Donnan, Peter T.; Santiago, Virginia Hernandez

doi:10.1016/j.jaci.2013.10.057

Cited by 70 publications

(45 citation statements)

References 32 publications

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“…This definition excludes those with a history of asthma in the past who no longer receive treatment, which are included in the non‐asthma population. It was also not possible to measure the prevalence of some other comorbidities including NSAID‐exacerbated respiratory disease which occurs in approximately 9%‐10% of patients with asthma, and for which selective COX‐2 inhibitors may be more appropriate in people requiring NSAIDs for the treatment of certain comorbidities such as pain and arthritis . Finally, further analytical work examining the impact of comorbidities on asthma severity, control and healthcare costs is still required for several comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Comorbidities in adults with asthma: Population‐based cross‐sectional analysis of 1.4 million adults in Scotland

Weatherburn

Guthrie

Mercer

et al. 2017

Clin Experimental Allergy

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Section: Discussionmentioning

confidence: 99%

Comorbidities in adults with asthma: Population‐based cross‐sectional analysis of 1.4 million adults in Scotland

Weatherburn

Guthrie

Mercer

et al. 2017

Clin Experimental Allergy

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“…The reaction typically starts with nasal symptoms within 30‐180 minutes after NSAIDs intake, followed by lower airways involvement . Exacerbations are related to the dose and COX‐1 inhibition potency, with weak COX‐1 inhibitors inducing milder respiratory symptoms and specific COX‐2 inhibitors rarely causing exacerbations . Although NERD patients were thought to be nonatopic, increasing evidence indicates that up to two thirds have a history of atopy …”

Section: Phenotypes In the Eaaci Classificationmentioning

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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“…This effect occurs with other NSAIDs that inhibit COX‐1. In contrast, COX‐2 inhibitors appear well tolerated in people with NERD experiencing respiratory reactions in response to aspirin or COX‐1‐inhibiting NSAIDs .…”

mentioning

confidence: 99%

NSAID‐exacerbated respiratory disease: a meta‐analysis evaluating prevalence, mean provocative dose of aspirin and increased asthma morbidity

Moralès

Guthrie

Lipworth

et al. 2015

Allergy

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Respiratory reactions triggered by oral aspirin in people with asthma are relatively common. At the population level, the prevalence of NERD was similar when measured using appropriately conducted OPCTs or by self-reported history. On average, respiratory reactions were triggered by clinically relevant doses of oral aspirin. Asthma morbidity was significantly increased in people with NERD who potentially require more intensive monitoring and follow-up.

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Safety risks for patients with aspirin-exacerbated respiratory disease after acute exposure to selective nonsteroidal anti-inflammatory drugs and COX-2 inhibitors: Meta-analysis of controlled clinical trials

Cited by 70 publications

References 32 publications

Comorbidities in adults with asthma: Population‐based cross‐sectional analysis of 1.4 million adults in Scotland

Comorbidities in adults with asthma: Population‐based cross‐sectional analysis of 1.4 million adults in Scotland

Progress in understanding hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs

NSAID‐exacerbated respiratory disease: a meta‐analysis evaluating prevalence, mean provocative dose of aspirin and increased asthma morbidity

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