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Position Statement of the Spanish Society of Allergology and Clinical Immunology on Provocation Tests with Aspirin/Nonsteroidal anti-inflammatory drugs

Izquierdo-Domínguez A1,2, Bobolea I3, Doña I4,5, Campo P4,5, Segura C6, Ortega N7, González R8, Delgado J6, Torres MJ4,5, Dordal MT9, and Behalf of the SEAIC Rhinoconjunctivitis Committee

1Allergy Service, Consorci Sanitari de Terrassa. Barcelona, Spain.
2Allergy Unit, Clínica Diagonal. Barcelona, Spain.
3Allergy Section. Servei de Pneumologia i Al.lèrgia Respiratòria. Hospital Clínic. Barcelona, Spain.
4Allergy Unit, Hospital Regional Universitario de Málaga. Málaga, Spain.
5Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.
6UGC Alergología, Hospital Universitario Virgen Macarena. Sevilla, Spain.
7Allergy Unit, H.U. de Gran Canaria Dr. Negrín. Las Palmas de Gran Canaria, Spain.
8Allergy Service, Hospital Universitario de Canarias. Tenerife, Spain.
9Allergy Unit, Servei de Medicina Interna, Hospital Universitari de Bellvitge. L’Hospitalet de Llobregat, Spain.

J Investig Allergol Clin Immunol 2020; Vol. 30(5)
doi: 10.18176/jiaci.0449

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used throughout the world. They are frequently involved in hypersensitivity reactions, which range from local or mild reactions to systemic and severe reactions. Consequently, it is necessary to perform an exhaustive study of patients in order to make an accurate diagnosis, search for safe procedures in the case of severe reactions, and identify alternative treatment options.
Various guidelines and protocols address the management of hypersensitivity to NSAIDs, although these vary widely from country to country. The Committees of Asthma, Rhinoconjunctivitis, and Drug Allergy of the Spanish Society of Allergy and Clinical Immunology (SEAIC) propose the present position statement on available options for challenge testing with aspirin/NSAIDs. This document is the fruit of an exhaustive review of current evidence and is based on recent publications addressing the diagnosis of patients with hypersensitivity to NSAIDs and on a consensus-oriented discussion among a group of experts from the SEAIC. The main objective has been to draft an easy-to-read, practical guideline for health care professionals in specialist areas who assess and manage patients with suspected hypersensitivity to NSAIDs. Furthermore, indications, contraindications, and procedures for oral, bronchial, and nasal provocation tests with aspirin/NSAIDs have been updated.

Key words: AERD, Aspirin, NSAID, NERD, Aspirin challenge