NSAID Single-Drug–Induced Reactions

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Key points

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are cyclooxygenase (COX) inhibitors with important analgesic, anti-inflammatory, antipyretic, and antithrombotic effects.

  • NSAIDs have been implicated in a variety of drug-induced reactions that are proved as or suspected of being mediated through a host immune response.

  • The types of single-drug–induced reactions are the confluence of 2 variables, namely the structure of the drug and the specific types of the immune responses.

Urticaria/angioedema/anaphylaxis

Selective NSAID acute HSRs have many features resembling type I hypersensitivity, although the identification of specific IgE antibody is usually not found.13 In anecdotal cases, however, demonstration either of a positive skin test or specific IgE to albumin-bound aspirin has been found.14, 15 The participation of mast cells in these reactions has been demonstrated by finding products of mast cell activation, including elevated serum tryptase levels.16 Any of the following clinical

Delayed reactions to NSAIDs

The group of delayed NSAID-specific reactions includes exanthems, pustular and bullous reactions, and organ-specific reactions (Box 2). T lymphocytes play a key role in the pathogenesis with drug specificity the hallmark of these reactions.

Diagnosis and management of delayed reactions to NSAIDs

The diagnosis of delayed reactions to NSAIDs is dependent on taking a careful history and assessing the clinical picture. Useful testing modalities may include patch testing for suspected T-cell–mediated reactions. The patches are placed with petrolatum and readings are conducted at 24 to 48 hours.71 There are case reports of patch testing as useful in fixed drug eruptions, DRESS, and AGEP.71 For fixed drug eruptions, the drug must be applied to the site where the original reaction occurred.72

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    Disclosures: K.M.W: None; M.C: Consultant Merck, Sanofi: Adverse Drug Reactions Board Committee.

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