Asia Pac Allergy.  2018 Oct;8(4):e38. 10.5415/apallergy.2018.8.e38.

Nonsteroidal anti-inflammatory drug hypersensitivity in the Asia-Pacific

• Thong BY

• KMID: 2423989
• DOI: http://doi.org/10.5415/apallergy.2018.8.e38

Abstract

Nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity reactions (HSRs) are often nonimmunologically mediated reactions which present with immediate HSR type manifestations. These are mediated by cyclooxygenase inhibition resulting in shunting towards the excessive production of leukotrienes. Important disease associations include asthma, nasal polyposis, and chronic spontaneous urticaria, especially among adults. The European Network on Drug Allergy/Global Allergy and Asthma European Network 2013 classification of NSAID HSR comprises nonselective HSR i.e., NSAID exacerbated respiratory disease (NERD), NSAIDs exacerbated cutaneous disease (NECD), NSAIDs induced urticarial-angioedema (NIUA); and selective (allergic) HSR i.e., single NSAID induced urticaria/angioedema or anaphylaxis, NSAIDs-induced delayed HSR. Much of the literature on genetic associations with NSAID HSR originate from Korea and Japan; where genetic polymorphisms have been described in genes involved in arachidonic acid metabolism, basophil/mast cell/eosinophil activation, various inflammatory mediators/cytokines, and different HLA genotypes. The Asian phenotype for NSAID HSR appears to be predominantly NIUA with overlapping features in some adults and children. NECD also appears to be more common than NERD, although both are not common in the Asian paediatric population. Between adults and children, children seem to be more atopic, although over time when these children grow up, it is likely that the prevalence of atopic adults with NSAID HSR will increase. Low-dose aspirin desensitization has been shown to be effective in the treatment of coronary artery disease, especially following percutaneous coronary intervention.

Keyword

Anaphylaxis; Asthma; Drugs; Hypersensitivity

MeSH Terms

Adult
Anaphylaxis
Anti-Inflammatory Agents, Non-Steroidal
Arachidonic Acid
Asian Continental Ancestry Group
Aspirin
Asthma
Child
Classification
Coronary Artery Disease
Drug Hypersensitivity*
Genotype
Humans
Hypersensitivity
Japan
Korea
Leukotrienes
Metabolism
Percutaneous Coronary Intervention
Phenotype
Polymorphism, Genetic
Prevalence
Prostaglandin-Endoperoxide Synthases
Urticaria
Anti-Inflammatory Agents, Non-Steroidal
Arachidonic Acid
Aspirin
Leukotrienes
Prostaglandin-Endoperoxide Synthases