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Original Article


Nonsteroidal Anti-inflammatory Drug Hypersensitivity Syndrome: A Multicenter Study II. Basophil Activation by Nonsteroidal Anti-inflammatory Drugs and Its Impact on Pathogenesis


AL De Weck,1 ML Sanz,1 PM Gamboa,2 JM Jermann,3 M Kowalski,4 W Medrala,5 J Sainte-Laudy,6 MS Schneider,3 JM Weber,3 A Wolanczyk-Medrala6

1Department of Allergology and Clinical Immunology, University of Navarra, Pamplona, Spain
2Hopital Basurto, Division of Allergy, Bilbao, Spain
3Bühlmann Laboratories, Allschwil, Switzerland
4Department of Medicine, University Hospital, Lodz, Poland
5Allergology Department, University Hospital, Wroclaw, Poland
6Centre Hospitalier Universitaire, Limoges, France

J Investig Allergol Clin Immunol 2010; Vol. 20(1): 39-57



Background: Patients who are clinically hypersensitive to nonsteroidal anti-inflammatory drugs (NSAIDs) sometimes present basophil activation in vitro, and in 50% of cases a parallel response to release of sulfidoleukotrienes (cellular allergen stimulation test) is observed. These phenomena occur not only in clinically hypersensitive patients, but also in some healthy controls who tolerate NSAIDs.

Material and Methods: We studied 16 clinically hypersensitive patients, 22 controls tolerating NSAIDs, and 29 healthy blood donors (clinical NSAID status unknown) using 2 different basophil isolation techniques (buffy coat or plasma leukocytes).

Results: In a population of 13 aspirin-tolerant healthy controls and 29 healthy blood donors, basophil activation with aspirin, diclofenac, and naproxen was analyzed at 4 different concentrations. The results in the 2 groups were quite similar in qualitative terms. Choosing a cutoff of 5% and a stimulation index >2, the proportion of positive results increased with the concentration. There were more positive results at all concentrations using the plasma leukocyte technique.

Conclusions: The most important fi nding of this study is that basophil activation by NSAIDs occurs not only in clinically hypersensitive patients but also, to a very variable extent and on an individual basis, in apparently normal healthy individuals who tolerate NSAIDs. The phenomenon is clearly dose-related, and hypersensitive patients seem to react to lower NSAID concentrations.

Key words: NSAID hypersensitivity. Basophil activation test. Multicenter study.