Clinical Characterization of a Large Population of Subjects with Respiratory Vs Cutaneous Non-Steroidal Anti-Inflammatory Drugs (NSAID) Hypersensitivity Reactions

Non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is an entity well differentiated from NSAID-induced urticaria/angioedema (NIUA). Our aim was to perform a comparative study of a large series of patients with NIUA and NERD. Patients referred between 2005-2015 with history of NERD and NIUA. Diagnosis was performed by clinical history and drug provocation test (DPT) (nasal: NERD, oral: NIUA) when indicated. DPT was also performed to test tolerance to alternative NSAID. Nine hundred and three patients included (NERD n=250, NIUA n=743). Most reactions were attributed to ibuprofen (60.8% NERD vs 56.4% NIUA, p=0.24), followed by aspirin (59.2% NERD vs 44% NIUA) (p=n.s.) and others (NERD 28.8% metamizol, NIUA 20.9% paracetamol). In NERD, reactions after taking NSAID were asthma (83%) and rhinitis (44%), whereas in NIUA were urticaria (73.7%) and angioedema (72.1%). Atopy was similar in both groups (NERD 57.9% vs NIUA 62.7%, p=0.23), with similar allergen distribution (NERD: D.pteronyssinus 36.2%, Olea 26.7%; NIUA: D. pteronyssinus 32%, Olea 28.9%). Nasal provocation test with lysine aspirin (NERD n=137) was positive in 69.4%. Paracetamol (1gr) was the most tolerated NSAID (NERD 81.9%, NIUA 73.7%). Celecoxib was the most tolerated selective COX-2 inhibitor (NERD 100%, NIUA 88.9%). Occurrence of reaction after NSAID intake was earlier in NERD vs. NIUA: aspirin (47 vs 80,9 min), ibuprofen (40,7 vs 161,6 min) and paracetamol (57,4 vs 165 min). NERD and NIUA share some characteristics despite being clinically different. More studies are needed to establish if those groups share or not a common causative mechanism.