Update on the Management of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity

Overview

Journal Yonsei Med J

Specialty General Medicine

Date 2019 Dec 31

PMID 31887794

Citations 8

Authors

Wan Yin Winnie Yeung

Hae Sim Park

Affiliations

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Abstract

The clinical phenotypes of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity are heterogeneous with various presentations including time of symptom onset, organ involvements, and underlying pathophysiology. Having a correct diagnosis can be challenging. Understanding their respective mechanisms as well as developing a comprehensive classification and diagnostic algorithm are pivotal for appropriate management strategy. Treatment modalities are based on the subtypes and severity of hypersensitivity reactions. Insights into the phenotypes and endotypes of hypersensitivity reactions enable personalized management in patients with suboptimal control of disease. This review updated the recent evidence of pathophysiology, classification, diagnostic algorithm, and management of NSAID hypersensitivity reactions.

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References

Liddament M, Husten J, Estephan T, Laine D, Mabon D, Pukac L . Higher Binding Affinity and Potency of Reslizumab for Interleukin-5 Compared With Mepolizumab. Allergy Asthma Immunol Res. 2019; 11(2):291-298. PMC: 6340799. DOI: 10.4168/aair.2019.11.2.291. View

Gamboa P, Sanz M, Caballero M, Urrutia I, Antepara I, Esparza R . The flow-cytometric determination of basophil activation induced by aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) is useful for in vitro diagnosis of the NSAID hypersensitivity syndrome. Clin Exp Allergy. 2004; 34(9):1448-57. DOI: 10.1111/j.1365-2222.2004.02050.x. View

Gaber F, Daham K, Higashi A, Higashi N, Gulich A, Delin I . Increased levels of cysteinyl-leukotrienes in saliva, induced sputum, urine and blood from patients with aspirin-intolerant asthma. Thorax. 2008; 63(12):1076-82. DOI: 10.1136/thx.2008.101196. View

Lee S, Nam Y, Koh Y, Kim S, Kim S, Kang H . Phenotypes of Severe Cutaneous Adverse Reactions Caused by Nonsteroidal Anti-inflammatory Drugs. Allergy Asthma Immunol Res. 2019; 11(2):212-221. PMC: 6340804. DOI: 10.4168/aair.2019.11.2.212. View

Berges-Gimeno M, Simon R, Stevenson D . Long-term treatment with aspirin desensitization in asthmatic patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2003; 111(1):180-6. DOI: 10.1067/mai.2003.7. View

Stone S, Phillips E, Wiese M, Heddle R, Brown S . Immediate-type hypersensitivity drug reactions. Br J Clin Pharmacol. 2013; 78(1):1-13. PMC: 4168374. DOI: 10.1111/bcp.12297. View

McGettigan P, Henry D . Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk: an examination of sales and essential medicines lists in low-, middle-, and high-income countries. PLoS Med. 2013; 10(2):e1001388. PMC: 3570554. DOI: 10.1371/journal.pmed.1001388. View

Liu T, Laidlaw T, Katz H, Boyce J . Prostaglandin E2 deficiency causes a phenotype of aspirin sensitivity that depends on platelets and cysteinyl leukotrienes. Proc Natl Acad Sci U S A. 2013; 110(42):16987-92. PMC: 3801005. DOI: 10.1073/pnas.1313185110. View

Hayashi H, Mitsui C, Nakatani E, Fukutomi Y, Kajiwara K, Watai K . Omalizumab reduces cysteinyl leukotriene and 9α,11β-prostaglandin F2 overproduction in aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2015; 137(5):1585-1587.e4. DOI: 10.1016/j.jaci.2015.09.034. View

10.

Stryjewska-Makuch G, Humeniuk-Arasiewicz M, Jura-Szoltys E, Gluck J . The Effect of Antileukotrienes on the Results of Postoperative Treatment of Paranasal Sinuses in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease. Int Arch Allergy Immunol. 2019; 179(4):281-289. DOI: 10.1159/000499134. View

11.

Lee J, Park J, Chang H, Park C . Complementary Participation of Genetics and Epigenetics in Development of NSAID-exacerbated Respiratory Disease. Allergy Asthma Immunol Res. 2019; 11(6):779-794. PMC: 6761071. DOI: 10.4168/aair.2019.11.6.779. View

12.

Asero R . Single NSAID hypersensitivity is associated with atopic status. Eur Ann Allergy Clin Immunol. 2015; 47(2):48-53. View

13.

Hill J, Burnett T, Katial R . Mechanisms of Benefit with Aspirin Therapy in Aspirin-Exacerbated Respiratory Disease. Immunol Allergy Clin North Am. 2016; 36(4):735-747. DOI: 10.1016/j.iac.2016.06.011. View

14.

Wohrl S . NSAID hypersensitivity - recommendations for diagnostic work up and patient management. Allergo J Int. 2018; 27(4):114-121. PMC: 6004000. DOI: 10.1007/s40629-018-0064-0. View

15.

Hanania N, Alpan O, Hamilos D, Condemi J, Reyes-Rivera I, Zhu J . Omalizumab in severe allergic asthma inadequately controlled with standard therapy: a randomized trial. Ann Intern Med. 2011; 154(9):573-82. DOI: 10.7326/0003-4819-154-9-201105030-00002. View

16.

Fandino M, Macdonald K, Lee J, Witterick I . The use of postoperative topical corticosteroids in chronic rhinosinusitis with nasal polyps: a systematic review and meta-analysis. Am J Rhinol Allergy. 2013; 27(5):e146-57. PMC: 3899544. DOI: 10.2500/ajra.2013.27.3950. View

17.

Scherer K, Brockow K, Aberer W, Gooi J, Demoly P, Romano A . Desensitization in delayed drug hypersensitivity reactions -- an EAACI position paper of the Drug Allergy Interest Group. Allergy. 2013; 68(7):844-52. DOI: 10.1111/all.12161. View

18.

Gauvreau G, OByrne P, Boulet L, Wang Y, Cockcroft D, Bigler J . Effects of an anti-TSLP antibody on allergen-induced asthmatic responses. N Engl J Med. 2014; 370(22):2102-10. DOI: 10.1056/NEJMoa1402895. View

19.

Bardelas J, Figliomeni M, Kianifard F, Meng X . A 26-week, randomized, double-blind, placebo-controlled, multicenter study to evaluate the effect of omalizumab on asthma control in patients with persistent allergic asthma. J Asthma. 2012; 49(2):144-52. DOI: 10.3109/02770903.2011.648296. View

20.

Sanchez-Borges M, Capriles-Hulett A . Atopy is a risk factor for non-steroidal anti-inflammatory drug sensitivity. Ann Allergy Asthma Immunol. 2000; 84(1):101-6. DOI: 10.1016/S1081-1206(10)62748-2. View