Natural evolution in patients with non-steroidal anti-inflammatory drugs -induced urticaria/angioedema

Abstract

Background

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent triggers of drug hypersensitivity with NSAIDs-induced urticaria/angioedema (NIUA) the most common phenotype. Loss of hypersensitivity has been reported for IgE-mediated reactions; however it has not been assessed in non-immunological reactions such as NIUA. We evaluated NSAID-hypersensitivity over time in NIUA patients.

Methods

Patients confirmed as NIUA by positive drug provocation test (DPT) with acetylsalicylic acid (ASA) during 2005-2012 (V1) were included (n=38). Subjects were prospectively reevaluated by DPT with ASA/other NSAIDs at two time points between 2013-2015 (V2 and V3). Atopy was assessed by skin prick test (SPT) using inhalant and food allergens.

Results

Patients were evaluated at V1 and reevaluated after 60 months (V2; IR:48-81) and a further 18 months (V3; IR:14-24). At V2, the majority (24; 63.15%) tolerated ASA and other NSAIDs (Group A) whilst 14 (36.84%) still reacted (Group B). At V3, all Group A patients remained tolerant; all Group B patients remained hypersensitive. The number of previous episodes reported at V1 and the percentage of reactions induced by ASA/ibuprofen were significantly lower in Group A (p=0.005 and p=0.006, respectively). Group A patients developed tolerance 72 months (IR:45-87) after their last evaluated reaction (V1); this interval was shorter in non-atopics (p=0.003), patients who experienced reactions over 1 hour after NSAIDs administration (p=0.001), and those who experienced isolated urticaria after NSAID intake (p=0.024).

Conclusions

NIUA patients may develop tolerance to NSAIDs over time, a process that seems to be influenced by atopy and type of clinical reaction.

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