Selective hypersensitivity to a single nonsteroidal anti-inflammatory drug

Area of Science:

• Pharmacology
• Immunology
• Clinical Medicine

Background:

• Nonsteroidal anti-inflammatory drug hypersensitivity (NIUH) encompasses various reactions.
• A specific subgroup, single nonsteroidal anti-inflammatory drug-induced hypersensitivity (SNIUAA), requires further characterization.

Purpose of the Study:

• To determine the frequency of SNIUAA.
• To describe the clinical and diagnostic features of SNIUAA.

Main Methods:

• Retrospective analysis of patients undergoing oral provocation tests (OPTs) for analgesics from 2004-2016.
• Phenotyping patients based on clinical history and OPT outcomes.

Main Results:

• SNIUAA was diagnosed in 44.3% of phenotyped patients.
• Diclofenac was the most frequent trigger (52.4%), followed by pyrazolones (30.7%).
• Selective diclofenac hypersensitivity was associated with a higher rate of anaphylaxis (40.0%).

Conclusions:

• SNIUAA is the predominant NIUH phenotype in this cohort.
• Diclofenac is the leading cause of SNIUAA and associated anaphylaxis.
• Diagnostic challenges often involve OPT with aspirin to confirm drug selectivity in suspected SNIUAA.