Blended reactions and angioedema are common in patients with cross-reactive nonsteroidal anti-inflammatory drug hypersensitivity.

IF 2.1 Q3 ALLERGY

Asia Pacific Allergy Pub Date : 2026-02-01 Epub Date: 2025-07-15 DOI:10.5415/apallergy.0000000000000211

Duy Le Pham, Huy Duc Le, Diep Khang Nguyen, Viet Hoang Nguyen, Nghi Man Ly, Huong Thi Bich Le, Son Xuan Huu Nguyen, Loc Duc Nguyen, Thu Trang Nguyen Mai, Khoa Anh Nguyen, Quoc Quang Luu, Hoang Kim Tu Trinh

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Abstract

Background: The European Academy of Allergology and Clinical Immunology (EAACI)/The Global Allergy and Asthma European Network (GA²LEN) guidelines recognize 3 phenotypes of cross-reactive nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity (NHS): NSAID-induced urticaria/angioedema (NIUA), NSAID-exacerbated cutaneous disease (NECD), and NSAID-exacerbated respiratory disease (NERD). However, numerous cases cannot be neatly classified into any of these groups.

Objective: This study investigated the phenotypes of cross-reactive NHS in Vietnamese patients.

Methods: Our retrospective study of 141 patients with cross-reactive NHS was conducted at the Allergy and Clinical Immunology Unit, University Medical Center Ho Chi Minh City, Vietnam. Patients were diagnosed with cross-reactive NHS if they had 3 or more reactions involving 3 or more different NSAIDs. Patients with an unclear history underwent single-blind oral challenge tests with aspirin to diagnose cross-reactive NHS. Reactions that did not align with any of the 3 standard phenotypes were defined as blended reactions (BRs).

Results: Among the 125 patients with cross-reactive NHS who exhibited cutaneous symptoms, 113 (90.4%) had angioedema with or without wheals and 12 (9.6%) had isolated wheals. However, the most common phenotype according to the EAACI classification was NIUA (66/141, 46.8%), followed by NECD (8/141, 5.7%) and NERD (4/141, 2.8%). BRs were determined in 63 patients (44.7%). The most common causative drug was paracetamol (63.8%). The alternative NSAIDs tolerated by most of the patients were etoricoxib (97.2%), celecoxib (95.9%), and meloxicam (94.3%).

Conclusions: BRs are a common phenotype in patients with cross-reactive NHS. Angioedema, with or without wheals, is an important clinical manifestation suggesting a cross-reactive NHS response. Highly selective COX-2 inhibitors are likely to be tolerated by most patients with cross-reactive NHS.

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混合反应和血管性水肿在交叉反应性非甾体抗炎药过敏患者中很常见。

背景：欧洲过敏学和临床免疫学学会(EAACI)/全球过敏和哮喘欧洲网络（GA²LEN）指南承认3种交叉反应性非甾体抗炎药（NSAID）超敏反应（NHS）： NSAID诱导的荨麻疹/血管性水肿（NIUA）、NSAID加重的皮肤病（NECD）和NSAID加重的呼吸道疾病（NERD）。然而，许多案例不能被整齐地归入任何一类。目的：本研究探讨越南患者交叉反应性NHS的表型。方法：我们在越南胡志明市大学医学中心过敏和临床免疫学部门对141例交叉反应性NHS患者进行了回顾性研究。如果患者有3种或3种以上不同非甾体抗炎药的3种或3种以上反应，则诊断为交叉反应性NHS。病史不明的患者接受阿司匹林单盲口服激发试验来诊断交叉反应性NHS。不符合3种标准表型的反应被定义为混合反应（BRs）。结果：在125例表现出皮肤症状的交叉反应性NHS患者中，113例（90.4%）有血管性水肿伴或不伴皮疹，12例（9.6%）有孤立性皮疹。然而，根据EAACI分类，最常见的表型是NIUA(66/141, 46.8%)，其次是NECD（8/141, 5.7%）和NERD（4/141, 2.8%）。63例（44.7%）患者进行了BRs检测。最常见的致病菌是扑热息痛（63.8%）。大多数患者耐受的替代非甾体抗炎药为依托昔布（97.2%）、塞来昔布（95.9%）和美洛昔康（94.3%）。结论：BRs是交叉反应性NHS患者的常见表型。血管性水肿，伴或不伴风疹，是一个重要的临床表现，提示交叉反应性NHS反应。大多数交叉反应性NHS患者可能耐受高选择性COX-2抑制剂。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asia Pacific Allergy ALLERGY-

CiteScore

2.50

自引率

5.90%

发文量

期刊介绍： Asia Pacific Allergy (AP Allergy) is the official journal of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI). Although the primary aim of the journal is to promote communication between Asia Pacific scientists who are interested in allergy, asthma, and clinical immunology including immunodeficiency, the journal is intended to be available worldwide. To enable scientists and clinicians from emerging societies appreciate the scope and intent of the journal, early issues will contain more educational review material. For better communication and understanding, it will include rational concepts related to the diagnosis and management of asthma and other immunological conditions. Over time, the journal will increase the number of original research papers to become the foremost citation journal for allergy and clinical immunology information of the Asia Pacific in the future.