Sensitivities to NSAIDs

It was the progenitor drug aspirin that was the first NSAID implicated in an allergic-Uke reaction when, in 1902, Hirschberg reported acute 

Sensitivity reactions occur with all NSAIDs regardless of structure, chanical and physical properties, anti-inflanunatory potency, COX selectivity, and differences in mechanism that may exist (e.g., with acetaminophen). There 

Sensitivity to COX inhibitors is rare in children with most reactions occurring to ibuprofen, aspirin, and acetaminophen in that order. Crossreactions between NSAIDs are frequent, but only about 10 % of NSAID-sensitive children react to acetaminophen and all of these patients react to other NSAIDs. 

The natural history of aspirin-induced asthma, or aspirin triad, begins with ihinorrhea and nasal congestion. This proceeds to rhinitis which becomes perennial and associated with chronic sinusitis and nasal polyps. Asthma develops 1-5 years after the onset of rhinitis. The disease usually appears at an age of 30-34 years and its course is usually more severe and progressive in women who outnumber men. 

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The charaderistics of classic and solid-state electrodes developed in the years 2000-2014 which are sensitive to NSAIDs are shown below. The contents of polymer membranes are similar. In case of small exceptions, the contents were included in the electrode description. 

The NSAIDs are contraindicated in patients with known hypersensitivity. There is a cross-sensitivity to other NSAIDs. Therefore, if a patient is allergic to one NSAID, there is an increased risk of an allergic reaction with any other NSAID. Hypersensitivity to aspirin is a contraindication for all NSAIDs. In general, the NSAIDs are contraindicated during the third trimester of pregnancy and during lactation. 

Cross-reactions with aspirin and NSAIDs are of practical importance. Typically, AIA patients are sensitive to all NSAIDs that preferentially inhibit COX-1 (table 2). Acetaminophen (paracetamol), a weak inhibitor of COX-1, is regarded as a relatively safe therapeutic alternative for almost all patients with AIA. High doses of the drug (>1,000 mg) have been reported to provoke mild, easily reversed bronchos-pasm in some AIA patients [13]. Some rare, well-documented cases of coexistence of aspirin and paracetamol sensitivity have been described. However, according to a recent meta-analysis, less that 2% of asthmatics are sensitive to both aspirin and paracetamol [14]. 

An indirect proof of the role exerted by gut bacteria in the pathogenesis of NSAID enteropathy is represented by the similarities between indomethacin-induced intestinal damage and Crohn s disease [234, 246], Not only are these lesions anatomically (both macro- and microscopically) similar [246], but also sensitive to the same drugs, e.g. sulfasalazine [234,247], steroids [234,247], immunosuppressive compounds [248], and antibiotics [234-237],... 

NSAID hypersensitivity Because of potential cross-sensitivity to other NSAIDs, do not give these agents to patients in whom aspirin or other NSAIDs have induced symptoms of asthma, rhinitis, urticaria, nasal polyps, angioedema, bronchospasm. 

The arylpropionic acid derivatives are useful for the treatment of rheumatoid arthritis and osteoarthritis, for reduction of mild to moderate pain and fever, and for pain associated with dysmenorrhea. Side effects of the drugs are similar to but less severe than those described for the salicylates. Those who are sensitive to salicylates also may be sensitive to and have adverse reactions when taking ibuprofen and related drugs. Acute hypersensitivity to ibuprofen has been reported in patients with lupus. The hypersensitivity reaction to sulindac can be fatal. The use of sulindac has also been linked to cases of acute pancreatitis. The use of dimethylsulfoxide (DMSO) topically in combination with sulindac has been reported to induce severe neuropathies. The concurrent use of ibuprofen with aspirin reduces the antiinflammatory effects of both drugs. Ibuprofen is contraindicated in patients with aspirin sensitivity leading to bronchiolar constriction and in patients with an-gioedema. As with all NSAIDs, renal and liver function should be normal for adequate clearance of the drugs. 

A small number of individuals exhibit aspirin intolerance or supersensitivity.84 These individuals comprise approximately 1 percent of the general population, but the incidence is considerably higher (10%-25%) in people with asthma or other hypersensitivity reactions.84,94 People with aspirin intolerance will display allergiclike reactions, including acute bronchospasm, urticaria, and severe rhinitis, within a few hours after taking aspirin and aspirinlike NSAIDs.45,76 These reactions may be quite severe, and cardiovascular shock may occur. Likewise, sensitivity to aspirin often indicates a concomitant sensitivity to other NSAIDs, including COX-2 selective drugs.92 Consequently, the use of all NSAIDs is contraindicated in these individuals.84... 

Aspirin-induced asthma has an onset of 30 minutes to 3 hours after ingestion. Affected individuals are cross-sensitive to all non-steroidal anti-inflammatory drugs (NSAIDs). Paracetamol is seldom associated with cross-sensitivity in patients with aspirin-induced asthma. Aspirin-induced asthma is believed to involve inhibition of COX-1. Patients should be provided with information on which drugs these are. 

Patients who are sensitive to aspirin shonld not be given any other NSAID becanse of possible cross-sensitivity reactions. Aspirin cross-sensitivity however, does not appear to occur with the nonacetylated salicylates such as sodium salicylate or choline salicylate. As mentioned previously, aspirin hypersensitivity is more prevalent in patients with asthma, rhinitis, or nasal polyposis. This syndrome has been termed the aspirin triad. ... 

Ketorolac tromethamine is contraindicated in patients while wearing soft contact lenses. Caution should be used with patients who have previously exhibited sensitivity to acetylsalicylic acid,phenylacetic acid derivatives, and other NSAIDs because a potential exists for cross-sensitivity. 

Several reports have documented the high risk of ketorolac in patients with a history of asthma, nasal polyposis, and sensitivity to aspirin or any other NSAID (SEDA-18, 105). Exacerbation of chronic asthma has been reported after the use of ketorolac eye-drops (SEDA-21, 106). 

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