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Multicenter Study
. 2023 Sep 1;51(5):84-92.
doi: 10.15586/aei.v51i5.946. eCollection 2023.

Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs in adults: Beyond current classification

Pamir Çerçi  1 , Reşat Kendirlinan  1 , Suna Büyüköztürk  2 , Aslı Gelincik  2 , Derya Ünal  2 , Semra Demir  2 , Ferda Öner Erkekol  3 , Gül Karakaya  4 , Adile Berna Dursun  5   6 , Serhat Çelikel  7 , Dane Ediger  8 , Oznur Abadoglu  9 , Sevim Bavbek  10
Affiliations
Multicenter Study

Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs in adults: Beyond current classification

Pamir Çerçi et al. Allergol Immunopathol (Madr). .

Abstract

Background: Hypersensitivity reactions (HSRs) to nonsteroidal anti-inflammatory drugs (NSAIDs) are a significant clinical issue. Several classifications have been proposed to categorize these reactions, including the current European Academy of Allergy and Clinical Immunology/European Network for Drug Allergy (EAACI/ENDA) classification. This study aimed to evaluate the applicability of this classification in a real-world clinical setting.

Methods: We conducted a national multicenter study involving patients from nine hospitals in four major urban centers in Turkey. All patients had a suggestive clinical history of hypersensitivity reactions to NSAIDs. Researchers collected data using a structured form and classified reactions based on the EAACI/ENDA classification. Oral provocation tests with several NSAIDs were performed using a single-blind challenge per EAACI/ENDA guidelines.

Results: Our retrospective study included 966 adult patients with a history of hypersensitivity to NSAIDs. The most common triggers were Acetylsalicylic Acid (ASA), paracetamol, and metamizole. The most prevalent acute NSAID hypersensitivity group was NSAID-induced urticaria/angioedema (NIUA) (34.3%). However, 17.3% of patients did not fit neatly into the current EAACI/ENDA classification. Notably, patients with underlying asthma or allergic rhinoconjunctivitis exhibited unusual reactions, such as urticaria and/or angioedema induced by multiple chemical groups of NSAIDs, blended mixed reactions, and isolated periorbital angioedema in response to multiple chemical groups of NSAIDs.

Conclusions: While the EAACI/ENDA classification system stratifies NSAID-induced hypersensitivity reactions into five distinct endotypes or phenotypes, it may not fully capture the diversity of these reactions. Our findings suggest a need for further research to refine this classification system and better accommodate patients with atypical presentations.

Keywords: Adverse Drug Reactions; Classification; Hypersensitivity; NSAIDs; Phenotyping.

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References

    1. 1. Asero R, Bavbek S, Blanca M, Blanca-Lopez N, Cortellini G, Nizankowska-Mogilnicka E, et al. Clinical management of patients with a history of urticaria/angioedema induced by multiple NSAIDs: An expert panel review. Int Arch Allergy Immunol. 2013;160(2):126–33. 10.1159/000342424 - DOI
    1. 2. Kowalski ML, Agache I, Bavbek S, Bakirtas A, Blanca M, Bochenek G, et al. Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)—A EAACI position paper. Allergy. 2019;74(1):28–39. 10.1111/all.13599 - DOI
    1. 3. Cortellini G, Romano A, Santucci A, Barbaud A, Bavbek S, Bignardi D, et al. Clinical approach on challenge and desensitization procedures with aspirin in patients with ischemic heart disease and nonsteroidal anti-inflammatory drug hypersensitivity. Allergy. 2017;72(3):498–506. 10.1111/all.13068 - DOI
    1. 4. Stevenson DD, Sanchez-Borges M, Szczeklik A. Classification of allergic and pseudoallergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann Allergy Asthma Immunol. 2001;87(3):177–80. 10.1016/S1081-1206(10)62221-1 - DOI
    1. 5. Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bousquet J, et al. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs)—Classification, diagnosis and management: Review of the EAACI/ENDA(#) and GA2LEN/HANNA*. Allergy. 2011;66(7):818–29. 10.1111/j.1398-9995.2011.02557.x - DOI

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