Hypersensitivity reactions to non-steroidal anti-inflammatory drugs: results of an Austrian cohort study

Teresa Bangerl,Wolfram Hoetzenecker,Brigitte Zahel,Emmanuella Guenova,Irena Angelova-Fischer,Andrea Lueger

doi:10.1007/s40629-020-00134-6

Abstract

Summary Background Hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of drug hypersensitivity. Despite the importance of NSAIDs in routine analgesia only few studies have systematically addressed the question of tolerability in hypersensitive patients. Methods The authors retrospectively analysed 398 patients that were treated at the Department of Dermatology, Kepler University Hospital Linz, Austria, in the period 2012–2016 with a clinical history of NSAID hypersensitivity. Skin tests (skin prick and intracutaneous tests) to common NSAIDs were performed, followed by single-blinded, placebo-controlled drug challenge with either the culprit drug or an alternative NSAID. Results A total of 361 patients were subjected to skin testing. Of these, 25 patients (6.3%) showed a positive reaction to the culprit drug. According to the severity of the reaction in the medical history, 87 patients were exposed orally to the culprit drug (oral provocation test, OPT) after negative skin test and 255 patients received OPT with alternative NSAIDs according to established protocols. OPT with the culprit drug resulted in hypersensitivity reactions in 12 patients (13.79%). In terms of alternative NSAID testing, the three most commonly tested drugs were lornoxicam (192 OPTs), acetaminophen (156 OPTs) and celecoxib (133 OPTs) with tolerability rates in respectively 88.54% (hypersensitivity reactions, 11.46%), 92.31% (hypersensitivity reactions, 7.69%) and 91.73% (hypersensitivity reactions, 8.27%) of cases. Conclusion OPT with alternative NSAIDs are useful in patients with NSAID hypersensitivity as tolerability varies between the individual substances.

Highlights

Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAID) comprise a broad spectrum of clinical and organ manifestations and have been considered the second most common cause of drug hypersensitivity [1]
The power of COX-1 inhibitors is directly related to the cross-reactivity between NSAIDs in patients with NSAID-exacerbated respiratory disease (NERD)
NSAID hypersensitivity reactions vary in terms of symptoms, time of onset, underlying chronic diseases and the involved pathophysiologic mechanisms or biochemical pathways [8,9,10]

Summary

Introduction

Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAID) comprise a broad spectrum of clinical and organ manifestations and have been considered the second most common cause of drug hypersensitivity [1]. Hypersensitivity reactions to non-steroidal anti-inflammatory drugs: results of an Austrian cohort study 227 original article the presence of concomitant asthma, rhinosinusitis and nasal polyps or underlying chronic urticaria [5, 6]. The power of COX-1 inhibitors is directly related to the cross-reactivity between NSAIDs in patients with NSAID-exacerbated respiratory disease (NERD). The commonly used classification system of NSAID intolerance comprises one respiratory type (NERD), two skin types (NSAIDinduced urticaria/angioedema [NIUA/NSAID] exacerbated cutaneous disease [NECD]) and two allergic types (single NSAID-induced urticara/angioedema or anaphylaxis [SNIUAA] and single NSAID-induced delayed reaction [SNIDR]) [11,12,13]

Methods

Results

Conclusion