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Practical Guidelines for Diagnosing Hypersensitivity Reactions to Nonsteroidal Anti-inflammatory Drugs


N Ortega,1 I Doña,2 E Moreno,3 MT Audicana,4 MJ Barasona,5 MP Berges-Gimeno,6 N Blanca-Lopez,7 T Lobera,8 A Padial,9 A Rosado,10 MJ Torres2

1Allergy Service, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain
2Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
3Allergy Service, Hospital Universitario de Salamanca, Salamanca, Spain
4Allergy Service, Santiago Apóstol Hospital, Vitoria-Gasteiz, Spain
5Allergy Service, Reina Sofía University Hospital, Córdoba, Spain
6Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain
7Allergy Service, Infanta Leonor Hospital, Madrid, Spain
8Allergy Service, Centro de Alta Resolución San Millán, Logroño, Spain
9Allergy Service, La Paz Hospital, Madrid, Spain
10Allergy Service, Alcorcón Hospital, Madrid, Spain

J Investig Allergol Clin Immunol 2014; Vol. 24(5): 308-323



Nonsteroidal anti-inflammatory drugs (NSAIDs) are the drugs most frequently involved in hypersensitivity reactions. These reactions include various clinical entities with different mechanisms leading to the release of inflammatory mediators. Characterization of patients based on clinical manifestations and suspected underlying mechanisms is critical for implementation of adequate diagnostic procedures and patient management. Our objectives were to prepare a systematic review of available scientific evidence and to provide general guidelines for the diagnosis and management of patients with hypersensitivity reactions to NSAIDs. We also propose a practical algorithm for the diagnosis of specific types of hypersensitivity to NSAIDs and provide recommendations for the management of hypersensitive patients.

Key words: Nonsteroidal anti-inflammatory drugs (NSAIDs). Hypersensitivity. Intolerance. Idiosyncrasy. Acetylsalicylic acid. Algorithm. Diagnosis.