Abstract
BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) are reported to be the second most common cause of drug hypersensitivity. In 2011, experts from the EAACI/ENDA group and GA2LEN proposed a new classification system for NSAID hypersensitivity. The aim of this study was to classify a patient cohort with a history of NSAID hypersensitivity according to this system.MethodsPatients with a clinical history of NSAID hypersensitivity referred to the Allergy Centre, Odense University Hospital between 2002 and 2011 and evaluated with oral provocation tests (OPTs) were included in the study. Medical records were retrospectively investigated with respect to the culprit NSAID(s), underlying diseases and symptoms at the primary reaction and during oral provocation tests (OPTs). Data was supplemented with a questionnaire. Classification according to EAACI guideline was based on these findings.ResultsIn total 149 patients were included. Of those, 39 patients (26.2%) had a positive OPT. Twenty-nine patients were classified as cross-reactive responders and 9 patients as single NSAID responders after positive OPTs with the culprit NSAID, but not to acetylsalicylic acid. All single NSAID responders reacted to non-pyrazolone drugs. Only one patient could not be classified according to the EAACI/ENDA system. An overlap between respiratory and cutaneous symptoms was found in 15/39 (38%) of patients.ConclusionsAll but one of our patients could be classified according to the EAACI classification system. Overlaps between different classes may occur much more commonly than expected.
Highlights
Non-steroidal anti-inflammatory drugs (NSAIDs) are reported to be the second most common cause of drug hypersensitivity
Our results suggest that an overlap in symptoms may be more common than previously expected, and one can argue that the nomenclature of the cross-reactive immediate reactions i.e. NSAIDsexacerbated respiratory disease (NERD), NSAIDs-exacerbated cutaneous disease (NECD) and NSAIDs-induced urticaria/angioedema (NIUA) can be misleading because symptoms from different organ systems can occur simultaneously
This study underlines the importance of performing an Oral provocation test (OPT) when establishing the diagnosis NSAIDhypersensitivity
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs) are reported to be the second most common cause of drug hypersensitivity. In 2011, experts from the EAACI/ENDA group and GA2LEN proposed a new classification system for NSAID hypersensitivity. The prevalence of NSAID hypersensitivity among patients with underlying diseases such as asthma and chronic urticaria is much higher, affecting up to 25% and 30% respectively [4,5]. Until recently no uniform definition or classification of NSAID hypersensitivity had been proposed. This changed in 2011 where experts from the EAACI/ENDA group and GA2LEN proposed a new classification system for NSAID hypersensitivity launching guidelines on diagnostic work-up and management [11]. The new classification system is based on knowledge about type of reaction, clinical manifestation, timing of the reaction, underlying diseases, cross-reactivity and putative mechanisms
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