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Basophil Activation Test for Investigation of IgE-Mediated Mechanisms in Drug Hypersensitivity
Published on: September 16, 2011
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NSAIDs-hypersensitivity often induces a blended reaction pattern involving multiple organs.
Inmaculada Doña1,2, Esther Barrionuevo3,4, María Salas3,4
1Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Malaga, Spain. inmadd@hotmail.com.
Scientific Reports
|November 14, 2018
Summary
Blended hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) involve multiple organs, often including skin, respiratory, and gastrointestinal symptoms. Nasal provocation tests are recommended for initial evaluation of NSAIDs-exacerbated respiratory disease and blended reactions.
Area of Science:
- Allergy and Immunology
- Pharmacology
- Clinical Medicine
Background:
- Non-steroidal anti-inflammatory drugs (NSAIDs)-induced hypersensitivity reactions are classified by ENDA into cross-reactive and selective types.
- Current classifications include NSAIDs-exacerbated respiratory disease (NERD) and NSAIDs-induced urticaria/angioedema (NIUA).
- Blended reactions, combining skin and respiratory symptoms or affecting other organs, are frequently observed but not well-characterized.
Purpose of the Study:
- To clinically characterize blended hypersensitivity reactions to NSAIDs.
- To compare the clinical features of blended reactions with NERD and NIUA.
- To investigate the diagnostic utility of nasal provocation tests in these conditions.
Main Methods:
- Evaluation of 880 patients with NSAIDs hypersensitivity between 2008-2015.
- Classification of patients into blended (261), NERD (108), and NIUA (511) groups based on clinical history and provocation tests.
- Comparison of symptoms, drugs, underlying diseases, and diagnostic methods (NPT-LASA, DPT).
Main Results:
- Blended reactions were observed in 29.6% of patients, with urticaria/angioedema plus rhinitis/asthma being the most common subtype (138 patients).
- Blended patients with respiratory symptoms showed higher rates of underlying rhinitis and asthma compared to NIUA.
- Nasal provocation test with lysine acetylsalicylate (NPT-LASA) showed similar positive rates in blended (77%) and NERD (78.7%) groups.
Conclusions:
- Blended reactions are NSAIDs hypersensitivity reactions affecting at least two organs, frequently including gastrointestinal symptoms.
- Patients with respiratory symptoms, regardless of other symptoms, should be initially evaluated with NPT-LASA due to its lower risk compared to DPT.
- NPT-LASA is a valuable diagnostic tool for both NERD and blended NSAIDs hypersensitivity reactions.
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