NSAID hypersensitivity - recommendations for diagnostic work up and patient management

Area of Science:

• Pharmacology
• Allergology
• Clinical Medicine

Background:

• Adverse drug reactions (ADR) to analgesics, specifically non-steroidal anti-inflammatory drug hypersensitivity (NSAID-HS), affect about 1.6% of patients.
• NSAID-HS presents a significant diagnostic challenge despite its prevalence.

Purpose of the Study:

• To provide an overview of diagnostic approaches for NSAID-HS.
• To differentiate between predictable Type A reactions and less common Type B reactions.

Main Methods:

• Literature review of selected scientific articles.
• Research conducted in PubMed and specialist databases, incorporating clinical guidelines.

Main Results:

• Approximately 80% of analgesic side effects are predictable Type A reactions, not requiring advanced diagnostics.
• Type B reactions, comprising 20%, include non-immunological NSAID-HS (NERD, NECD, NIUA) and rarer true allergies (SNIUAA, SNIDR).
• True NSAID allergies (SNIUAA, SNIDR) are not cross-reactive, allowing tolerance of other NSAIDs.

Conclusions:

• Diagnosis begins with a thorough patient history; skin and in vitro tests have limited utility.
• Provocation testing is often necessary for definitive diagnosis and identifying tolerable alternative analgesics.
• Individualized patient management strategies can resolve most cases of NSAID-HS.