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J Investig Allergol Clin Immunol. 2017;27(1):32-39. doi: 10.18176/jiaci.0080.

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

Author information

1
Allergy Service, Infanta Leonor University Hospital, Madrid, Spain.
2
Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.
3
Research Laboratory, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.
4
Chemical Technology Institute, UPV-CSIC, Polytechnic University of Valencia, Valencia, Spain.
5
Allergy Unit, Pneumology and Allergy Service, Clinic Hospital, Barcelona, Spain.
6
Department of Pharmacology, University of Extremadura, Caceres, Spain.

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.

KEYWORDS:

Cross-hypersensitivity; Immediate reactions; NSAID-hypersensitivity; Selective reactions

PMID:
28211343
DOI:
10.18176/jiaci.0080
[Indexed for MEDLINE]
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