Updating the classification and routine diagnosis of NSAID hypersensitivity reactions: A WAO Statement

Antonino Romano; Rocco L. Valluzzi; Emilio Alvarez-Cuesta; Ignacio Ansotegui; Riccardo Asero; Annick Barbaud; Joan Bartra; Sevim Bavbek; Katherine N. Cahill; Pascal Demoly; Inmaculada Doña; María A. Guzmán Meléndez; Mona Kidon; Lily Li; Ricardo Madrigal-Burgaleta; Joanna S. Makowska; Hae-Sim Park; César Picado; Marek Sanak; Masami Taniguchi; Andrew A. White; Marina Atanaskovic-Markovic; Marina Attanasi; Marcelo Vivolo Aun; Maria Pilar Berges-Gimeno; Lorena Bernal-Rubio; Knut Brockow; Lucrecia Bustamante; Carlo Caffarelli; Yoon-Seok Chang; Manana Chikhladze; Luis Felipe Ensina; Bryan N. Fernandes; Lene Heise Garvey; Pedro Giavina-Bianchi; Eva Gómes; Semanur Kuyucu; Marina Labella; Cristobalina Mayorga; Francesca Mori; Mauro Pagani; Valeria Palma-Pino; Claudio Parisi; Elizabeth Phillips; Elizabeth Powell; Michelle Ramien; Louise Savic; Emilio Solano-Solares; Luciana Kase Tanno; Paula Vazquez-Revuelta; Timothy Watts; Masao Yamaguchi; Review Panel Members

doi:10.1016/j.waojou.2025.101086

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Updating the classification and routine diagnosis of NSAID hypersensitivity reactions: A WAO Statement

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Updating the classification and routine diagnosis of NSAID hypersensitivity reactions: A WAO Statement

Antonino Romano, Rocco L. Valluzzi, Emilio Alvarez-Cuesta, Ignacio Ansotegui, Riccardo Asero, Annick Barbaud, Joan Bartra, Sevim Bavbek, Katherine N. Cahill, Pascal Demoly, …

The World Allergy Organization journal, Vol.18(8), pp.101086-101086

01/08/2025

DOI: https://doi.org/10.1016/j.waojou.2025.101086

PMID: 40837856

Résumé

Drug challenge

NSAID-Exacerbated or -induced food allergy (NEFA/NIFA)

NSAID-Induced urticaria/angioedema/anaphylaxis (NIUAA)

Patch tests

Skin tests

Update

Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) have been classified as immediate (or acute) and delayed. Immediate reactions can be further classified into 4 clinical types: NSAID-exacerbated respiratory disease (N-ERD), NSAID-exacerbated cutaneous disease (NECD), NSAID-induced urticaria/angioedema (NIUA), and single NSAID-induced urticaria/angioedema/anaphylaxis (SNIUAA). Specifically, the NIUA type references reactions to ≥2 NSAIDs belonging to different chemical groups, involving urticaria and/or angioedema in patients with no underlying chronic spontaneous urticaria. However, there are patients meeting cross-reactive criteria for NIUA phenotype who report reactions that involve 2 organ systems (eg, cutaneous and respiratory; cutaneous and gastrointestinal) and have been termed “blended”. In pediatrics, this type of reaction is recognized and has been termed NSAID-induced urticaria/angioedema/anaphylaxis (NIUAA), an acronym we suggest be extended now to adults. There are small subgroups of N-ERD patients who also report skin symptoms and, alternatively, NECD patients who report respiratory symptoms. These 2 subgroups could be diagnosed as having mixed N-ERD and mixed NECD, respectively. In fact, they are patients suffering from N-ERD or NECD who have had reactions consistent with anaphylaxis. In the current classifications of NSAID hypersensitivity, the reactions in which NSAIDs act as aggravating factors or cofactors in subjects with sensitization to foods are not included. Recently, this type of reactions has been defined as NSAID-exacerbated food allergy (NEFA) and NSAID-induced food allergy (NIFA), respectively. This Statement of the World Allergy Organization (WAO) aims to update both the classification of hypersensitivity reactions to NSAIDs and their diagnosis, addressing the novel issues.

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Titre: Updating the classification and routine diagnosis of NSAID hypersensitivity reactions: A WAO Statement
Créateurs - sans rôle: Antonino Romano - Oasi Research Institute – IRCCS, Troina, Italy & BIOS S.p.A. Società Benefit, Rome, Italy
Rocco L. Valluzzi - Bambino Gesù Children's Hospital
Emilio Alvarez-Cuesta - Frm CD Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain
Ignacio Ansotegui - Hospital Quironsalud Bizkaia, Bilbao-Erandio, Spain
Riccardo Asero - Allergy Department, Clinica San Carlo, Paderno Dugnano, Milan, Italy
Annick Barbaud - Assistance Publique – Hôpitaux de Paris
Joan Bartra - Department of Allergy, Hospital Clinic of Barcelona, University of Barcelona & Institutd’ Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETIC ARADyAL, RICORs REI, Barcelona, Spain
Sevim Bavbek - Ankara University
Katherine N. Cahill - Vanderbilt University Medical Center
Pascal Demoly - IDESP, Univ. Montpellier – INSERM, and Department of Pulmonology, Division of Allergy, University Hospital of Montpellier, Montpellier, France
Inmaculada Doña - Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, ARADyAL, Málaga, Spain
María A. Guzmán Meléndez - Section of Immunology, HIV and Allergy, Department of Medicine, Clinical Hospital University of Chile, Santiago, Chile
Mona Kidon - Clinical Immunology, Angioedema and Allergy Unit, Pediatric Allergy Clinic, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel & Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
Lily Li - Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
Ricardo Madrigal-Burgaleta - Allergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
Joanna S. Makowska - Medical University of Lodz, Lodz, Poland
Hae-Sim Park - Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
César Picado - Pulmonology Department, Hospital Clinic, CIBERES, IDIBAPS, University of Barcelona, Barcelona, Spain
Marek Sanak - Jagiellonian University
Masami Taniguchi - Sagamihara National Hospital, Sagamihara, Japan
Andrew A. White - Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA, USA
Marina Atanaskovic-Markovic - University Children's Hospital, Belgrade
Marina Attanasi - Pediatric Allergy and Pulmonology Unit, Department of Pediatrics, University of Chieti, Chieti, Italy
Marcelo Vivolo Aun - Faculdade Israelita de Ciências da Saúde Albert Einstein School of Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
Maria Pilar Berges-Gimeno - Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain
Lorena Bernal-Rubio - Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain
Knut Brockow - Technical University of Munich
Lucrecia Bustamante - Sección de Alergia., Especialista en Emergencias, Medica Staff – CEA, Hospital Italiano de Buenos Aires Buenos, Aires, Argentina
Carlo Caffarelli - University of Parma
Yoon-Seok Chang - Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
Manana Chikhladze - Akaki Tsereteli State University
Luis Felipe Ensina - Universidade de São Paulo
Bryan N. Fernandes - Barts Health NHS Trust
Lene Heise Garvey - Gentofte Hospital
Pedro Giavina-Bianchi - Universidade de São Paulo
Eva Gómes - Serviço de Imunoalergologia Centro hospitalar universitário de Santo António Porto, Portugal
Semanur Kuyucu - Department of Pediatric Allergy and Immunology, Mersin University, Faculty of Medicine, Mersin, Turkey
Marina Labella - Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, ARADyAL, Málaga, Spain
Cristobalina Mayorga - Instituto de Investigación Biomédica de Málaga
Francesca Mori - Allergy Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
Mauro Pagani - Medicine Department, Medicine Ward Mantova Hospital, ASST di Mantova, Mantova, Italy
Valeria Palma-Pino - Section of Immunology, HIV and Allergy, Internal Medicine Department, Clinical Hospital University of Chile, Santiago, Chile
Claudio Parisi - Pediatric and Adults Allergy Sections, Italian Hospital of Buenos Aires, Argentina
Elizabeth Phillips - Vanderbilt University Medical Center
Elizabeth Powell - Children's Allergy Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK
Michelle Ramien - Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Canada
Louise Savic - Leeds Teaching Hospitals NHS Trust, UK
Emilio Solano-Solares - Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain
Luciana Kase Tanno - Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France
Paula Vazquez-Revuelta - Allergy Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona, Spain
Timothy Watts - Department of Respiratory Medicine & Allergy, Homerton Healthcare NHS Foundation Trust, London, UK
Masao Yamaguchi - Teikyo University Chiba Medical Center
Review Panel Members
Détails de publication: The World Allergy Organization journal, Vol.18(8), pp.101086-101086
Éditeur: Elsevier Inc
Identifiants: 99150213809311
Unité académique: Institut Desbrest d Epidemiologie et de Sante Publique - IDESP
Langue: English
Type de ressource: Journal article