NSAIDs-Induced Anaphylaxis

Opinion Statement

Drugs are between the main triggers of anaphylaxis. They have been described as major cause of fatal anaphylaxis. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed drugs around the world because of their analgesic, anti-inflammatory, antipyretic, and antithrombotic effects. This class of drug is the first or the second after antibiotics as the cause of drug hypersensitivity reactions, including anaphylaxis. However, frequency of NSAIDs as the drug implicated in anaphylactic reactions is too variable among different countries. We believe there are discrepancies between genetics, frequency of exposure and mainly between classification of hypersensitivity reactions to NSAIDs and definition of anaphylaxis. Actual classification of NSAIDs hypersensitivity considers as anaphylaxis only those severe reactions presented by selective responders, probably IgE-mediated. Blended reactions, when respiratory plus mucocutaneous symptoms are presented after intaking NSAIDs from different groups (cross-intolerant), are not included in this classification. It can lead to underdiagnosis of non-immunological anaphylaxis. International groups of researchers must try to better define phenotypes of hypersensitivity reactions to NSAIDs, in order to include those blended reactions and better manage these cases.

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