title: Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified.
abstract: OBJECTIVE
  Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors.
  
  
  METHODS
  Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration.
  
  
  RESULTS
  From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients.
  
  
  CONCLUSIONS
  Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.
authors.affiliation: Allergy Service, Infanta Leonor University Hospital, Madrid, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Pérez-Alzate
authors.affiliation: Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.|Research Laboratory, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Cornejo-García
authors.affiliation: Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Pérez-Sánchez
authors.affiliation: Chemical Technology Institute, UPV-CSIC, Polytechnic University of Valencia, Valencia, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Andreu
authors.affiliation: Allergy Unit, Pneumology and Allergy Service, Clinic Hospital, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: García-Moral
authors.affiliation: Department of Pharmacology, University of Extremadura, Caceres, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Agúndez
authors.affiliation: Allergy Unit, Pneumology and Allergy Service, Clinic Hospital, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bartra
authors.affiliation: Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Doña
authors.affiliation: Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Torres
authors.affiliation: Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Blanca
authors.affiliation: Allergy Service, Infanta Leonor University Hospital, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Blanca-López
authors.affiliation: Allergy Service, Infanta Leonor University Hospital, Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Canto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced / Q000175:diagnosis* / Q000276:immunology; D000799:Angioedema / Q000139:chemically induced / Q000175:diagnosis* / Q000276:immunology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000276:immunology; D001241:Aspirin / Q000008:administration & dosage* / Q000276:immunology; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007159:Immunologic Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013030:Spain; D014581:Urticaria / Q000139:chemically induced / Q000175:diagnosis* / Q000276:immunology; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
keywords: Cross-hypersensitivity; Immediate reactions; NSAID-hypersensitivity; Selective reactions