title: Natural evolution in patients with nonsteroidal anti-inflammatory drug-induced urticaria/angioedema.
abstract: BACKGROUND
  Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent triggers of drug hypersensitivity with NSAIDs-induced urticaria/angioedema (NIUA) the most common phenotype. Loss of hypersensitivity has been reported for IgE-mediated reactions; however, it has not been assessed in nonimmunological reactions such as NIUA. We evaluated NSAID-hypersensitivity over time in NIUA patients.
  
  
  METHODS
  Patients confirmed as NIUA by positive drug provocation test (DPT) with acetylsalicylic acid (ASA) during 2005-2012 (V1) were included (n=38). Subjects were prospectively re-evaluated by DPT with ASA/other NSAIDs at two time points between 2013 and 2015 (V2 and V3). Atopy was assessed by skin prick test (SPT) using inhalant and food allergens.
  
  
  RESULTS
  Patients were evaluated at V1 and re-evaluated after 60 months (V2; IR:48-81) and a further 18 months (V3; IR:14-24). At V2, the majority (24; 63.15%) tolerated ASA and other NSAIDs (Group A) while 14 (36.84%) still reacted (Group B). At V3, all Group A patients remained tolerant; all Group B patients remained hypersensitive. The number of previous episodes reported at V1 and the percentage of reactions induced by ASA/ibuprofen were significantly lower in Group A (P=.005 and P=.006, respectively). Group A patients developed tolerance 72 months (IR:45-87) after their last evaluated reaction (V1); this interval was shorter in nonatopics (P=.003), patients who experienced reactions over 1 hour after NSAIDs administration (P=.001), and those who experienced isolated urticaria after NSAID intake (P=.024).
  
  
  CONCLUSIONS
  NIUA patients may develop tolerance to NSAIDs over time, a process that seems to be influenced by atopy and type of clinical reaction.
authors.affiliation: Allergy Unit, Regional University Hospital of Malaga-IBIMA, Malaga, Spain.
authors.forename: I
authors.identifier: http://orcid.org/0000-0002-5309-4878
authors.initials: I
authors.lastname: Doña
authors.affiliation: Allergy Unit, Regional University Hospital of Malaga-IBIMA, Malaga, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Barrionuevo
authors.affiliation: Allergy Unit, Regional University Hospital of Malaga-IBIMA, Malaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Salas
authors.affiliation: Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Malaga, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Cornejo-García
authors.affiliation: Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Malaga, Spain.
authors.forename: J R
authors.initials: JR
authors.lastname: Perkins
authors.affiliation: Allergy Unit, Regional University Hospital of Malaga-IBIMA, Malaga, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Bogas
authors.affiliation: Allergy Unit, Regional University Hospital of Malaga-IBIMA, Malaga, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Prieto
authors.affiliation: Allergy Unit, Regional University Hospital of Malaga-IBIMA, Malaga, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Torres
mesh_terms: D000328:Adult; D000799:Angioedema / Q000139:chemically induced*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D008297:Male; D011446:Prospective Studies; D012882:Skin Tests; D013997:Time Factors; D014581:Urticaria / Q000139:chemically induced* / Q000276:immunology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
keywords: NSAID-induced urticaria/angioedema; Nonsteroidal anti-inflammatory drugs; atopy; hypersensitivity; urticaria