Selective Immediate Hypersensitivity Reactions To NSAIDs
Selective Immediate Hypersensitivity Reactions To NSAIDs
Purpose of Review: Selective immediate reactions to NSAIDs imply that patients develop a urticarial/anaphylactic response to a single drug with good tolerance to other compounds. No systematic review of these reactions has yet been made.
Recent Findings: With the increase in consumption of NSAIDs, these have become one of the most common drugs inducing hypersensitivity reactions. Although cross-intolerance reactions are the most common, a significant proportion is selective responses. As specific IgE antibodies are not always found, there is only indirect evidence supporting an IgE-mediated mechanism in selective NSAID reactors.
Summary: Selective immediate reactions to NSAIDs must be considered when a patient develops urticaria or anaphylaxis after intake of one drug with good tolerance to drugs from other groups or even a drug from the same group with a slightly different chemical structure. Further research is required to identify the antigenic determinant structures recognized.
NSAIDs are the group of drugs most frequently involved in hypersensitivity drug reactions, followed by beta-lactam antibiotics and, to a lesser extent, quinolones, radiocontrast media and muscle relaxants.
Although cross-intolerance between different NSAIDs is much more common, selective NSAID reactions have also been reported. Almost all NSAIDs have been implicated in both IgE and T-cell dependent reactions. Selective NSAID reactions differ from those that occur in cross-intolerance in that good tolerance exists to the remaining NSAIDs, even if they are strong cyclooxygenase-1 (COX-1) inhibitors. In some instances, an IgE-mediated mechanism can be demonstrated. However, in others, only indirect evidence points to this mechanism, and further studies are required. The relevant literature is scanty, and no detailed studies or systematic series have been published to date.
Abstract and Introduction
Abstract
Purpose of Review: Selective immediate reactions to NSAIDs imply that patients develop a urticarial/anaphylactic response to a single drug with good tolerance to other compounds. No systematic review of these reactions has yet been made.
Recent Findings: With the increase in consumption of NSAIDs, these have become one of the most common drugs inducing hypersensitivity reactions. Although cross-intolerance reactions are the most common, a significant proportion is selective responses. As specific IgE antibodies are not always found, there is only indirect evidence supporting an IgE-mediated mechanism in selective NSAID reactors.
Summary: Selective immediate reactions to NSAIDs must be considered when a patient develops urticaria or anaphylaxis after intake of one drug with good tolerance to drugs from other groups or even a drug from the same group with a slightly different chemical structure. Further research is required to identify the antigenic determinant structures recognized.
Introduction
NSAIDs are the group of drugs most frequently involved in hypersensitivity drug reactions, followed by beta-lactam antibiotics and, to a lesser extent, quinolones, radiocontrast media and muscle relaxants.
Although cross-intolerance between different NSAIDs is much more common, selective NSAID reactions have also been reported. Almost all NSAIDs have been implicated in both IgE and T-cell dependent reactions. Selective NSAID reactions differ from those that occur in cross-intolerance in that good tolerance exists to the remaining NSAIDs, even if they are strong cyclooxygenase-1 (COX-1) inhibitors. In some instances, an IgE-mediated mechanism can be demonstrated. However, in others, only indirect evidence points to this mechanism, and further studies are required. The relevant literature is scanty, and no detailed studies or systematic series have been published to date.
Source...