Journal ArticleDOI
Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs
Marek L. Kowalski,Riccardo Asero,Sevim Bavbek,Miguel Blanca,Natalia Blanca-López,Grazyna Bochenek,Knut Brockow,Paloma Campo,Gülfem Çelik,Josefina Cernadas,G Cortellini,Eva Rebelo Gomes,Ewa Nizankowska-Mogilnicka,Antonino Romano,Andrzej Szczeklik,S. Testi,María José Torres,Stefan Wöhrl,Joanna Makowska +18 more
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TLDR
This document, prepared by a panel of experts from the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity, aims at reviewing the current knowledge in the field and proposes uniform definitions and clinically useful classification of hypersensitivity reactions to NSAIDs.Abstract:
Hypersensitivity reactions to aspirin (acetylsalicylic acid) and other nonsteroidal anti-inflammatory drugs (NSAIDs) constitute only a subset of all adverse reactions to these drugs, but due to their severity pose a significant burden to patients and are a challenge to the allergist. In susceptible individuals, NSAIDs induce a wide spectrum of hypersensitivity reactions with various timing, organ manifestations, and severity, involving either immunological (allergic) or nonimmunological mechanisms. Proper classification of reactions based on clinical manifestations and suspected mechanism is a prerequisite for the implementation of rational diagnostic procedures and adequate patient management. This document, prepared by a panel of experts from the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity, aims at reviewing the current knowledge in the field and proposes uniform definitions and clinically useful classification of hypersensitivity reactions to NSAIDs. The document proposes also practical algorithms for the diagnosis of specific types of NSAIDs hypersensitivity (which include drug provocations, skin testing and in vitro testing) and provides, when data are available, evidence-based recommendations for the management of hypersensitive patients, including drug avoidance and drug desensitization.read more
Citations
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Journal ArticleDOI
Mechanisms of Anaphylaxis Beyond IgE.
TL;DR: The mechanisms underlying anaphylaxis are complex and involve several interrelated pathways, and some of these pathways may be key to the development of anphylaxis, while others may only modulate the severity of the reaction.
Journal ArticleDOI
Drug Hypersensitivity: How Drugs Stimulate T Cells via Pharmacological Interaction with Immune Receptors
Werner J. Pichler,Jacqueline Adam,Stephan Watkins,Natascha Andrea Wuillemin,James Yun,Daniel Yerly +5 more
TL;DR: Analysis of drug-induced immune reactions revealed that off-target activities also affect immune receptors, such as highly polymorphic human leukocyte antigens (HLA) or T cell receptors (TCR), which may lead to T cell stimulation, resulting in clinical symptoms of delayed-type hypersensitivity.
Journal ArticleDOI
Approaches to the diagnosis and management of patients with a history of nonsteroidal anti-inflammatory drug-related urticaria and angioedema.
TL;DR: A practical clinical approach to the patient with NSAID-induced urticaria and angioedema is presented, and chemically nonrelated COX-1 inhibitors can be safely used.
Journal ArticleDOI
Precision Medicine in Chronic Rhinosinusitis with Nasal Polyps.
TL;DR: This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.
Journal Article
Trends in hypersensitivity drug reactions: more drugs, more response patterns, more heterogeneity.
Inmaculada Doña,Esther Barrionuevo,Natalia Blanca-López,M.J. Torres,Tahia D. Fernandez,Cristobalina Mayorga,Gabriela Canto,Miguel Blanca +7 more
TL;DR: Five well-defined clinical entities, the most common of which is NSAID-induced urticaria/angioedema, have been proposed in a new consensus classification.
References
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Journal ArticleDOI
Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients
Munir Pirmohamed,Sally James,Shaun Meakin,Chris D. Green,A Scott,Tom Walley,Keith Farrar,B. Kevin Park,Alasdair Breckenridge +8 more
TL;DR: The burden ofADRs on the NHS is high, accounting for considerable morbidity, mortality, and extra costs, and measures need to be put into place to reduce the burden of ADRs and thereby further improve the benefit:harm ratio of the drugs.
Journal ArticleDOI
A new system for grading recommendations in evidence based guidelines
Robin Harbour,Juliet Miller +1 more
TL;DR: A revised system of determining levels of evidence and grades for guideline recommendations is published, based on the work of the US Agency for Healthcare Research and Quality and its applicability to the target population of the guideline.
Journal ArticleDOI
Intolerance to Aspirin: Clinical Studies and Consideration of its Pathogenesis
Max Samter,Ray F. Beers +1 more
Journal ArticleDOI
Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations.
Werner Aberer,Andreas J. Bircher,Antonino Romano,Miguel Blanca,Paolo Campi,Javier Fernández,Knut Brockow,Werner J. Pichler,Pascal Demoly +8 more
TL;DR: A drug provocation test (DPT) is the controlled administration of a drug in order to diagnose drug hypersensitivity reactions under medical surveillance, whether this drug is an alternative compound, or structurally/pharmacologically related, or the suspected drug itself.
Journal ArticleDOI
Delayed Drug Hypersensitivity Reactions
TL;DR: This review presents newer concepts of the role of T cells in drug hypersensitivity, which evolved from the study of drug-specific T Cells in various drug-induced hypersensitivity diseases.
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