Korean J Intern Med.  2016 May;31(3):417-432. 10.3904/kjim.2016.085.

What we know about nonsteroidal anti-inflammatory drug hypersensitivity

• Pham DL
• Kim JH
• Trinh TH
• Park HS

• KMID: 2163498
• DOI: http://doi.org/10.3904/kjim.2016.085

Abstract

Nonsteroidal anti-inf lammatory drugs (NSAIDs) are widely prescribed for the treatment of inflammatory diseases, but their use is frequently related to hypersensitivity reactions. This review outlines our current knowledge of NSAID hypersensitivity (NHS) with regard to its pathogenic, molecular, and genetic mechanisms, as well as diagnosis and treatment. The presentation of NHS varies from a local (skin and/or airways) reaction to systemic reactions, including anaphylaxis. At the molecular level, NHS reactions can be classified as cross-reactive (mediated by cyclooxygenase inhibition) or selective (specific activation of immunoglobulin E antibodies or T cells). Genetic polymorphisms and epigenetic factors have been shown to be closely associated with NHS, and may be useful as predictive markers. To diagnose NHS, inhalation or oral challenge tests are applied, with the exclusion of any cross-reactive NSAIDs. For patients diagnosed with NHS, absolute avoidance of NSAIDs/aspirin is essential, and pharmacological treatment, including biologics, is often used to control their respiratory and cutaneous symptoms. Finally, desensitization is recommended only for selected patients with NHS. However, further research is required to develop new diagnostic methods and more effective treatments against NHS.

Keyword

Anti-inflammatory agents, non-steroidal; Drug hypersensitivity; Etiology; Genetic predisposition to disease

MeSH Terms

Anaphylaxis
Anti-Inflammatory Agents, Non-Steroidal
Antibodies
Biological Products
Diagnosis
Drug Hypersensitivity*
Epigenomics
Genetic Predisposition to Disease
Humans
Hypersensitivity
Immunoglobulin E
Immunoglobulins
Inhalation
Polymorphism, Genetic
Prostaglandin-Endoperoxide Synthases
Anti-Inflammatory Agents, Non-Steroidal
Antibodies
Biological Products
Immunoglobulin E
Immunoglobulins
Prostaglandin-Endoperoxide Synthases