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Aspirin and NSAID sensitivity.

Donald D Stevenson1

  • 1Division of Allergy, Asthma, and Immunology, Department of Medicine, Scripps Clinic and The Scripps Research Institute, W 205, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA. stevensn@scripps.edu

Immunology and Allergy Clinics of North America
|July 10, 2004
PubMed
Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) blocking cyclo-oxygenase-1 (COX-1) can trigger asthma and urticaria. Even selective COX-2 inhibitors may sensitize patients, leading to reactions upon re-exposure.

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Area of Science:

  • Pharmacology
  • Immunology
  • Respiratory Medicine

Background:

  • Aspirin and older nonsteroidal anti-inflammatory drugs (NSAIDs) are known to trigger adverse reactions.
  • Cyclo-oxygenase-1 (COX-1) inhibition is implicated in these reactions, particularly in patients with specific conditions.

Purpose of the Study:

  • To investigate the cross-reactivity patterns of various NSAIDs based on their COX-1 and COX-2 inhibition profiles.
  • To understand the potential for sensitization and subsequent reactions to NSAIDs, including selective COX-2 inhibitors.

Main Methods:

  • The study reviews existing data on NSAID-induced reactions, categorizing drugs by their COX-1 and COX-2 inhibitory potency.
  • Analysis focuses on dose-dependent cross-reactivity and the potential for sensitization.

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Main Results:

  • NSAIDs that potently inhibit COX-1, like aspirin, induce asthma and urticaria in susceptible individuals.
  • Weaker or partial COX-1 inhibitors show cross-reactivity only at high doses.
  • While selective COX-2 inhibitors do not initially cross-react, all NSAIDs can sensitize patients, leading to anaphylaxis or urticaria upon subsequent exposure.

Conclusions:

  • The degree of COX-1 inhibition dictates the likelihood of immediate cross-reactivity.
  • All NSAIDs, regardless of COX selectivity, carry a risk of sensitization and future hypersensitivity reactions.
  • Careful consideration of NSAID class and patient history is crucial for managing hypersensitivity.