Exploration of Asthma & Allergy

Table 3. Classification of non-allergic vs. allergic non-steroidal anti-inflammatory hypersensitivity—adolescent population > 10 years.

Characteristic	Reaction type
Characteristic	Non-allergic NSAID-exacerbated respiratory disease (NERD)	NSAID-exacerbated cutaneous disease (NECD)	NSAID-induced urticaria/angioedema/anaphylaxis (NIUAA)	Allergic selective NSAID-induced urticaria, angioedema, or anaphylaxis (SNIUAA)	Allergic selective NSAID-induced delayed reactions (SNIDR)
Clinical features	Respiratory (bronchospasm, dyspnoea, nasal congestion, rhinorrhoea)	Cutaneous (urticaria and/or angioedema)	Urticaria and/or angioedema ± respiratory symptoms	Urticaria, angioedema, anaphylaxis	Cutaneous and mucosal eruptions (maculo-papular, fixed drug eruption); severe cutaneous reactions (AGEP, DRESS, SJS/TEN); organ-specific manifestations (hepatitis, nephritis)
Onset	Immediate (minutes–hours)	Immediate (minutes–hours)	Immediate (minutes–hours)	Immediate (< 1 h)	Delayed (> 24 h)
Mechanism	Non-allergic mechanism due to COX-1 inhibition	Non-allergic mechanism due to COX-1 inhibition	Non-allergic mechanism due to COX-1 inhibition	IgE-mediated	T-cell mediated
Cross-reactivity	Present across structurally unrelated NSAIDs	Present across structurally unrelated NSAIDs	Present across structurally unrelated NSAIDs	Absent	Absent
Associated factors	Patients with asthma, chronic rhinosinusitis, or chronic urticaria	Chronic urticaria	Unknown	Unknown	Unknown

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COX: cyclooxygenase; SJS: Stevens-Johnson syndrome; TEN: toxic epidermal necrolysis; AGEP: acute generalised exanthematous pustulosis; DRESS: drug reaction with eosinophilia and systemic symptoms; 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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