Exploration of Asthma & Allergy

Table 2. Classification of non-allergic vs. allergic non-steroidal anti-inflammatory hypersensitivity—paediatric population < 10 years.

Characteristic	Reaction type
Characteristic	Non-immunological NSAID hypersensitivity (NERD/NECD/NIUA)	Selective immediate NSAID allergy [selective NSAID-induced urticaria, angioedema, or anaphylaxis (SNIUAA)]	Selective delayed NSAID hypersensitivity (SNIDR)
Clinical features	Cutaneous (urticaria/angioedema), respiratory, ocular, or systemic symptoms, including anaphylaxis	Acute urticaria, angioedema, or anaphylaxis to a single agent	Heterogeneous, including fixed drug eruptions and severe cutaneous reactions (e.g., SJS/TEN)
Onset	Typically, within minutes to a few hours	Usually within 1 h	Delayed onset, generally beyond 24 h
Mechanism	Non-allergic mechanism due to COX-1 inhibition	IgE-mediated hypersensitivity	T-cell-driven immune response
Cross-reactivity	Present across structurally unrelated NSAIDs	Absent	Absent
Associated factors	Patients with asthma, chronic rhinosinusitis, or chronic urticaria	Unknown	Unknown

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COX: cyclooxygenase; NECD: NSAID-exacerbated cutaneous disease; NERD: NSAID-exacerbated respiratory disease; NIUA: NSAID-induced urticaria/angioedema; SJS: Stevens-Johnson syndrome; SNIDR: selective NSAID-induced delayed reactions; TEN: toxic epidermal necrolysis; NSAID: non-steroidal anti-inflammatory drug.

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Author contributions

AA: Conceptualization, Visualization, Data curation, Formal analysis, Methodology, Writing—original draft, Writing—review & editing. CB: Conceptualization, Data curation, Writing—original draft, Writing—review & editing. KD: Writing—review & editing. ML: Conceptualization, Visualization, Writing—review & editing, Methodology, Supervision. All authors read and approved the submitted version.

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The authors declare that they have no conflicts of interest.

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