Cross-reactive reactions to nonsteroidal anti-inflammatory drugs

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequent causes of adverse drug reactions, particularly in patients with asthma and chronic idiophatic urticaria. Many subjects report cutaneous and/or respiratory symptoms and, less frequently, anaphylactic shock after the administration of one (single-reactors) or different (cross-reactors) drugs of this class. Diagnosis: There are no reliable cutaneous or in vitro tests which allow NSAID hypersensitivity to be identified in patients with cross-reactive reactions; therefore, the challenge test is considered the "gold standard" for establishing or excluding a diagnosis of NSAID hypersensitivity in such patients. Management: Culprit drugs should always be avoided by patients with suspected or well-established multiple hypersensitivity to NSAIDs. The therapeutic options range from the administration of alternative drugs - such as weak cyclooxygenase (COX)-1 inhibitors and/or preferential or highly selective COX-2 inhibitors to desensitization to the culprit ones. Conclusion: In patients with different NSAID-induced reactions, the challenge test with both culprit drugs and alternative ones is the only method to establish a reliable diagnosis of NSAID hypersensitivity and to find some alternative therapeutic options, respectively. In specific cases, drug desensitization can also be performed. However, further studies are required to improve management of such patients.