title: What we know about nonsteroidal anti-inflammatory drug hypersensitivity.
abstract: Nonsteroidal anti-inf lammatory drugs (NSAIDs) are widely prescribed for the treatment of inflammatory diseases, but their use is frequently related to hypersensitivity reactions. This review outlines our current knowledge of NSAID hypersensitivity (NHS) with regard to its pathogenic, molecular, and genetic mechanisms, as well as diagnosis and treatment. The presentation of NHS varies from a local (skin and/or airways) reaction to systemic reactions, including anaphylaxis. At the molecular level, NHS reactions can be classified as cross-reactive (mediated by cyclooxygenase inhibition) or selective (specific activation of immunoglobulin E antibodies or T cells). Genetic polymorphisms and epigenetic factors have been shown to be closely associated with NHS, and may be useful as predictive markers. To diagnose NHS, inhalation or oral challenge tests are applied, with the exclusion of any cross-reactive NSAIDs. For patients diagnosed with NHS, absolute avoidance of NSAIDs/aspirin is essential, and pharmacological treatment, including biologics, is often used to control their respiratory and cutaneous symptoms. Finally, desensitization is recommended only for selected patients with NHS. However, further research is required to develop new diagnostic methods and more effective treatments against NHS.
authors.affiliation: Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.|Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, Korea.
authors.forename: Duy Le
authors.initials: DL
authors.lastname: Pham
authors.affiliation: Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Ji-Hye
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Tu Hoang Kim
authors.initials: TH
authors.lastname: Trinh
authors.affiliation: Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.|Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, Korea.
authors.forename: Hae-Sim
authors.initials: HS
authors.lastname: Park
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced* / Q000235:genetics / Q000276:immunology / Q000628:therapy; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001688:Biological Products / Q000627:therapeutic use; D003888:Desensitization, Immunologic / Q000379:methods; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000235:genetics / Q000276:immunology / Q000628:therapy; D044127:Epigenesis, Genetic; D020022:Genetic Predisposition to Disease; D006801:Humans; D007159:Immunologic Tests; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001688:Biological Products
keywords: Anti-inflammatory agents, non-steroidal; Drug hypersensitivity; Etiology; Genetic predisposition to disease