Recent Updates in Understanding NSAID Hypersensitivity

Purpose of Review To provide a review of available literature regarding nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity with an emphasis on more recent findings. Recent Findings Oral provocation tests with aspirin are important for diagnosis and management in adult and pediatric populations with reported NSAID hypersensitivity. Risk of cross-reactivity to COX-2 inhibitors varies by NSAID hypersensitivity phenotype. COX-2 inhibitors are tolerated in aspirin-exacerbated respiratory disease. Reported NSAID allergy is associated with a higher risk of a substance use disorder. Effective treatment of underlying chronic spontaneous urticaria can allow tolerance of NSAIDs in NSAID-exacerbated cutaneous disease. Summary The pathophysiology, cross-reactivity, and appropriate diagnostic evaluation differ between the 5 distinct NSAID hypersensitivity phenotypes. Further research into the pathophysiology of NSAID hypersensitivity in patients with and without underlying disease is needed.

Automated summary

This review provides an overview of recent studies on nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, particularly emphasizing the importance of oral provocation tests in diagnosis and management, the varying risk of cross-reactivity to COX-2 inhibitors, and effective treatment of NSAID-exacerbated cutaneous disease. The pathophysiology, cross-reactivity, and diagnostic evaluation differ among the five distinct phenotypes of NSAID hypersensitivity, and further research is needed to understand the underlying mechanisms in patients with and without underlying disease.