Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified.

Abstract

BACKGROUND AND OBJECTIVES:

Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors.

METHODS:

Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration.

RESULTS:

From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients.

CONCLUSIONS:

Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.

• Authors: D Pérez-Alzate, J A Cornejo-García, N Pérez-Sánchez, I Andreu, A García-Moral, J A Agúndez, J Bartra, I Doña, M J Torres, M Blanca, N Blanca-López, G Canto
• Journal: Journal of investigational allergology & clinical immunology (J Investig Allergol Clin Immunol) 2017 Vol. 27 Issue 1 Pg. 32-39 ISSN: 1018-9068 [Print] Spain
• PMID: 28211343 (Publication Type: Journal Article)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Aspirin

Topics

• Adolescent
• Adult
• Aged
• Anaphylaxis (chemically induced, diagnosis, immunology)
• Angioedema (chemically induced, diagnosis, immunology)
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, immunology)
• Aspirin (administration & dosage, immunology)
• Cross Reactions
• Drug Hypersensitivity (diagnosis, immunology)
• Female
• Humans
• Immune Tolerance
• Immunologic Tests
• Male
• Middle Aged
• Predictive Value of Tests
• Reproducibility of Results
• Spain
• Urticaria (chemically induced, diagnosis, immunology)
• Young Adult