ATLANTA, GA—Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD) and cutaneous NSAID-induced urticaria/angioedema (NIUA) hypersensitivity reactions involve similarities that suggest the possibility of shared molecular mechanisms, according to a comparative study presented at the 2017 AAAAI Annual Meeting.

“There were no differences in atopy in NERD versus NIUA,” noted lead study author Jesus Verge, of Virgen de la Victoria Hospital-IBIMA, in Malaga, Spain, and coauthors. More research into causal mechanisms is needed, the researchers cautioned. “Ibuprofen was the drug most frequently involved in both groups.”

Paracetamol and celecoxib were the best-tolerated NSAIDs in the study, they noted. The most frequent NERD symptoms were asthma and chronic rhinitis with or without nasal polyps.

A total of 993 patients treated between 2005 and 2015 who had histories of NERD (n=250) and NIUA (n=743) were diagnosed using clinical and, in some cases, drug provocation test (DPT) criteria; most patients in both groups were women. 

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“Most reactions were attributed to ibuprofen followed by aspirin, and others,” the researchers reported. Differences in NERD and NIUA were statistically significant only for aspirin (59.2% vs. 44%; P<0.0001) and paracetamol (13.2% vs. 20.9%; P=0.0068).

Among patients with NERD, NSAIDs provoked asthmatic reactions in 83% of patients and rhinitis in 44% of patients. In patients with NIUA, NSAIDs provoked urticaria in 74% of patients and angioedema in 72%, the team reported.

“Atopy was similar in both groups (NERD: 58% vs. NIUA 63%; P=0.23 [not significant]) with similar allergen distribution,” the authors noted.

Paracetamol (1g) was best tolerated; it was tolerated in 82% of patients with NERD and 74% of patients with NIUA. Celecoxib was the best-tolerated selective COX-2 inhibitor (100% and 89% in patients with NERD and NIUA, respectively).