A Practical Approach to NSAID Allergy
DOI:
https://doi.org/10.58931/cait.2024.4371Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for pain management and inflammation. Acetylsalicylic acid (ASA) is a commonly used treatment for cardiovascular diseases including acute coronary syndromes. Reactions to NSAIDs can vary widely, ranging from exacerbation of underlying cutaneous and respiratory conditions to anaphylaxis and delayed hypersensitivity reactions (DHRs). A thorough clinical history is essential for diagnosing NSAID hypersensitivity, with a focus on the systems involved, reaction timing, and the presence and control of comorbid allergic conditions. Although commonly referred to as an allergy, the mechanisms behind these reactions are not solely IgE-mediated. As such, the authors will primarily use the term “hypersensitivity reactions” in concordance with the latest American Academy of Allergy, Asthma and Immunology (AAAAI) drug allergy practice parameter. While NSAID hypersensitivity reactions may cross-react among cyclooxygenase-1 (COX-1) inhibitors, reactions to selective cyclooxygenase-2 (COX-2) inhibitors are rare and they are typically well tolerated as alternative agents.
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