ArticleAsia Pacific allergy2026
Blended reactions and angioedema are common in patients with cross-reactive nonsteroidal anti-inflammatory drug hypersensitivity.
Article in Asia Pacific allergy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The European Academy of Allergology and Clinical Immunology (EAACI)/The Global Allergy and Asthma European Network (GA²LEN) guidelines recognize 3 phenotypes of cross-reactive nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity (NHS): NSAID-induced urticaria/angioedema (NIUA), NSAID-exacerbated cutaneous disease (NECD), and NSAID-exacerbated respiratory disease (NERD). However, numerous cases cannot be neatly classified into any of these groups. Objective: This study investigated the phenotypes of cross-reactive NHS in Vietnamese patients. Methods: Our retrospective study of 141 patients with cross-reactive NHS was conducted at the Allergy and Clinical Immunology Unit, University Medical Center Ho Chi Minh City, Vietnam. Patients were diagnosed with cross-reactive NHS if they had 3 or more reactions involving 3 or more different NSAIDs. Patients with an unclear history underwent single-blind oral challenge tests with aspirin to diagnose cross-reactive NHS. Reactions that did not align with any of the 3 standard phenotypes were defined as blended reactions (BRs). Results: Among the 125 patients with cross-reactive NHS who exhibited cutaneous symptoms, 113 (90.4%) had angioedema with or without wheals and 12 (9.6%) had isolated wheals. However, the most common phenotype according to the EAACI classification was NIUA (66/141, 46.8%), followed by NECD (8/141, 5.7%) and NERD (4/141, 2.8%). BRs were determined in 63 patients (44.7%). The most common causative drug was paracetamol (63.8%). The alternative NSAIDs tolerated by most of the patients were etoricoxib (97.2%), celecoxib (95.9%), and meloxicam (94.3%). Conclusions: BRs are a common phenotype in patients with cross-reactive NHS. Angioedema, with or without wheals, is an important clinical manifestation suggesting a cross-reactive NHS response. Highly selective COX-2 inhibitors are likely to be tolerated by most patients with cross-reactive NHS.
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