title: Hypersensitivity reactions to non-steroidal anti-inflammatory drugs.
abstract: NSAIDs are the most important group of drugs involved in hypersensitivity drug reactions, and include heterogeneous compounds with very different chemical structures. These reactions can be IgE dependent (immediate reactions), T cell-mediated (non-immediate), or induced by a non-specific immunological mechanism related with the blocking of the COX-1 enzyme and the shunting to the lipooxygenase pathway (cross-intolerant reactions). Cutaneous symptoms are the most frequent, with ibuprofen, naproxen and diclofenac being common culprit drugs worldwide, although others can be involved because patterns of consumption and exposure rates vary between countries. A very important proportion of immunological reactions are immediate, with urticaria and anaphylaxis being the typical clinical manifestations. Non-immediate reactions comprise a number of heterogeneous entities ranging from mild exanthema to severe TEN or DRESS syndrome, as well as organ-specific reactions such as hepatitis or pneumonitis. Cross-intolerant reactions appear to non-chemically related drugs, and involve respiratory airways, skin or both. In vivo diagnostic tests are based on the capacity of the skin to respond to the culprit drug, but their sensitivity is in many instances rather low. The approach for in vitro testing consists of either detecting specific IgE antibodies or studying the proliferation of T lymphocytes toward the eliciting drug. No appropriate tests are yet available for the in vitro validation of cross-intolerance reactions, although techniques based on the stimulation of basophils have been proposed. Based on these findings, the diagnostic approach is often based on the controlled administration of the drug to assess tolerance. In this work we review current knowledge on hypersensitivity reactions to NSAIDs, including diagnostic approach and genetic studies.
authors.affiliation: Research Group of Allergic Diseases, Research Laboratory, IMABIS Foundation-Carlos Haya Hospital, Málaga, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Cornejo-Garcia
authors.forename: Natalia
authors.initials: N
authors.lastname: Blanca-López
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Doña
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Andreu
authors.forename: José A G
authors.initials: JA
authors.lastname: Agúndez
authors.forename: Miguel
authors.initials: M
authors.lastname: Carballo
authors.forename: Miguel
authors.initials: M
authors.lastname: Blanca
authors.forename: María Gabriela
authors.initials: MG
authors.lastname: Canto
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000737:chemistry; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology* / Q000235:genetics / Q000276:immunology; D020022:Genetic Predisposition to Disease; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced* / Q000175:diagnosis / Q000235:genetics / Q000276:immunology; D006969:Hypersensitivity, Immediate / Q000139:chemically induced* / Q000175:diagnosis / Q000235:genetics / Q000276:immunology; D015394:Molecular Structure; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013329:Structure-Activity Relationship
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal