[Summary: Hypersensitivity to Analgesics: intolerance or allergy?]

Area of Science:

• Pharmacology
• Immunology
• Clinical Medicine

Background:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) can trigger both non-immunologically mediated intolerance reactions and true allergic reactions.
• Intolerance reactions to NSAIDs are more frequent than allergic reactions.
• Clinical symptoms, including cutaneous and respiratory manifestations, often do not distinguish between intolerance and allergy.

Purpose of the Study:

• To differentiate between NSAID intolerance and allergy.
• To elucidate the pathogenetic mechanisms underlying NSAID hypersensitivity.
• To guide the selection of alternative analgesics for patients with NSAID intolerance.

Main Methods:

• Review of clinical presentations and pathogenetic mechanisms of NSAID hypersensitivity.
• Analysis of the role of cyclooxygenase (COX) inhibition in NSAID intolerance.
• Examination of cross-reactivity patterns in NSAID intolerance versus allergy.

Main Results:

• NSAID intolerance is primarily mediated by cyclooxygenase (COX) inhibition, particularly COX-1.
• Broad cross-reactivity to structurally unrelated NSAIDs is characteristic of NSAID intolerance.
• Allergic reactions to NSAIDs typically show cross-reactivity only to structurally related compounds.

Conclusions:

• NSAID intolerance and allergy present similarly but have distinct pathogenetic mechanisms and cross-reactivity profiles.
• Understanding the mechanism of NSAID intolerance is key to predicting cross-reactivity.
• Identifying well-tolerated alternative analgesics is essential for managing patients with NSAID intolerance.