<p>NSAID-induced reactions: classification, prevalence, impact, and management strategies</p>

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the leading cause of hypersensitivity drug reactions. The different chemical structures, cyclooxygenase 1 (COX-1) and/or COX-2 inhibitors, are taken at all ages and some can be easily obtained over the counter. Vasoactive inflammatory mediators like histamine and leukotriene metabolites can produce local/systemic effects. Responders can be selective (SR), IgE or T-cell mediated, or cross-intolerant (CI). Inhibition of the COX pathway is the common mechanism in CI, with the skin being the most frequent organ involved, followed by the lung and/or the nose. An important number of cases have skin and respiratory involvement, with systemic manifestations ranging from mild to severe anaphylaxis. Among SR, this is the most frequent entity, often being severe. Recent years have seen an increase in reactions involving the skin, with many cases having urticaria and/or angioedema in the absence of chronic urticaria. Aspirin, the classical drug involved, has now been replaced by other NSAIDs, with ibuprofen being the universal culprit. For CI, no in vivo/in vitro diagnostic methods exist and controlled administration is the only option unless the cases evaluated report repetitive and consistent episodes with different NSAIDs. In SR, skin testing (patch and intradermal) with 24–48 reading can be useful, mainly for delayed T-cell responses. Acetyl salicylic acid (ASA) is the test drug to establish the diagnosis and confirm/exclude CI by controlled administration. Desensitization to ASA has been extensively used in respiratory cases though it can also be applied in those cases where it is required.

Novel association between asthma and osteoarthritis: a nationwide health and nutrition examination survey

“…However, this comorbidity may be under-recognized in those who prefer a sedentary lifestyle to cope with joint pain or dyspnea. Furthermore, there is concern that non-steroidal anti-inflammatory drugs (NSAIDs), which are commonly prescribed to patients with OA, may aggravate the symptoms of asthma [8]. Therefore, examining the prevalence and relationship of OA and asthma is essential to understand their clinical implications on aspects such as physical activity and QOL.…”

Ibuprofen-induced Anaphylactic Shock in Adult Saudi Patient

“…It is a type I immediate hypersensitivity reaction, and there is no cross-reactivity with other groups of NSAIDs. However, there are reports of cross-reactivity among closely related NSAIDs [13,[15][16][17]. In our patient's case, she had ibuprofen-induced anaphylaxis.…”

“…Recently NSAIDs were classified as the most common cause of hypersensitivity drug reaction overtaking β-lactam antibiotics [12]. NSAIDs are implicated in a wide range of adverse reactions ranging from simple rhinitis/rhino-sinusitis to anaphylactic shock and systemic vasculitis [13]. Classification of these reactions proved difficult due to multiple mechanisms and a variety of presentations.…”

Are Kidney-Tonifying and Blood-Activating Medicinal Herbs Better than NSAIDs for Knee Osteoarthritis? A Systematic Review and Meta-Analysis

“…Debilitating diseases such as rheumatoid arthritis and osteoarthritis are commonly managed by NSAIDs. However, the pharmacological mechanism of NSAIDs is often associated with the presence of gastrointestinal side effects [73, 74]. NSAIDs are recognized as the most common drugs involved in hypersensitivity drug reactions [75–78].…”