Koh Young-Il, Yu Ji Eun, Sim Da Woon
Division of Allergy, Asthma and Clinical Immunology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea.
Clin Transl Sci. 2025 Sep;18(9):e70335. doi: 10.1111/cts.70335.
Nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity reactions are commonly reported but often overestimated due to reliance on clinical history alone. Accurate diagnosis and identification of safe alternative medications are essential for appropriate management. This retrospective study aimed to evaluate the clinical manifestations of NSAID hypersensitivity, assess the diagnostic value and safety of aspirin oral provocation testing, and investigate the tolerability of alternative medications, including acetaminophen, meloxicam, and celecoxib. Patients diagnosed with NSAID hypersensitivity through aspirin provocation testing at a single tertiary hospital were included. Demographics, reaction phenotypes, time intervals from index reactions, provocation outcomes, and tolerability to alternative agents were analyzed. Based on the aspirin provocation results, 36, 24, 192, and 58 patients were classified as having NSAID-exacerbated cutaneous disease, NSAID-exacerbated respiratory disease, NSAID-induced urticaria/angioedema, and NSAID-induced blended reactions (NIBR), respectively. Among patients suspected of NIBR based on clinical history, the confirmation rate was 74.1%. Overall, 832 oral provocation tests with alternative drugs were performed in 310 patients: 309 with acetaminophen, 307 with celecoxib, and 216 with meloxicam. The tolerability rates for acetaminophen 1300 mg, meloxicam 15 mg, and celecoxib 200 mg were 90%, 96%, and 98%, respectively. Epinephrine was administered in 19.4% of patients overall, with the highest rate observed in the NIBR group (44.8%); however, no patients required hospitalization or experienced fatal outcomes following the provocation test. Aspirin provocation testing and sequential evaluation of alternative medications can be safely performed in outpatient settings when conducted by experienced allergists. Clinical history alone is insufficient for diagnosing NSAID hypersensitivity, and confirmatory testing is crucial to avoid unnecessary drug avoidance and support accurate delabeling.
非甾体抗炎药（NSAID）过敏反应常有报告，但由于仅依赖临床病史，往往被高估。准确诊断和识别安全的替代药物对于恰当治疗至关重要。这项回顾性研究旨在评估NSAID过敏的临床表现，评估阿司匹林口服激发试验的诊断价值和安全性，并研究对包括对乙酰氨基酚、美洛昔康和塞来昔布在内的替代药物的耐受性。纳入了在一家三级医院通过阿司匹林激发试验诊断为NSAID过敏的患者。分析了人口统计学特征、反应表型、距首次反应的时间间隔、激发试验结果以及对替代药物的耐受性。根据阿司匹林激发试验结果，分别有36例、24例、192例和58例患者被分类为患有NSAID加重的皮肤病、NSAID加重的呼吸道疾病、NSAID诱发的荨麻疹/血管性水肿以及NSAID诱发的混合反应（NIBR）。在基于临床病史怀疑为NIBR的患者中，确诊率为74.1%。总体而言，310例患者共进行了832次替代药物口服激发试验：对乙酰氨基酚309次、塞来昔布307次、美洛昔康216次。对乙酰氨基酚1300毫克、美洛昔康15毫克和塞来昔布200毫克的耐受率分别为90%、96%和98%。总体上19.4%的患者使用了肾上腺素，在NIBR组中观察到的比例最高（44.8%）；然而，激发试验后没有患者需要住院或出现致命后果。当由经验丰富的过敏症专科医生进行时，阿司匹林激发试验和替代药物的序贯评估可以在门诊安全进行。仅靠临床病史不足以诊断NSAID过敏，确证性检测对于避免不必要的药物回避和支持准确的去标签至关重要。
