NSAIDs, the most prescribed drugs in the world, are responsible for many adverse reactions among the population. Symptoms to watch out for
I am 62 years old and a lozenge to relieve a sore throat (containing a minimal amount of ibuprofen) triggered a respiratory reaction which made me discover that I was allergic to NSAIDs (non-steroidal anti-inflammatory drugs). I will therefore have to avoid acetylsalicylic acid, ibuprofen and most of the painkillers that I have taken in the past without problems. Isn’t it strange that a drug allergy occurs at my age?
What signs could have made him suspect his presence?
He replies Julia of ColoAllergist and immunologist, San Raffaele Hospital, Milan (GO TO THE FORUM)
Non-steroidal anti-inflammatories are the most prescribed drugs worldwide and among most responsible for adverse reactions in the population, both because of their characteristics and their widespread use. The mechanism by which the reaction is triggered isinhibition of the Cox-1 enzyme which determines, in predisposed subjects, a greater production of leukotrienes, the chemical mediators responsible for allergic reactions. The disorder may appear the first time the drug is taken, but also after years of use; in most cases there is no production of the antibodies typical of allergies (the so-called IgE, responsible for all true allergic reactions, detectable with the so-called skin prick tests and laboratory tests), but it actually triggers a reaction with the same symptoms, which is difficult to distinguish from a clinical point of view.
In fact, demonstrations are usually urticaria and/or angioedema, but also asthma, rhinitis and more rarely anaphylaxis. The subject who presented the adverse reaction to an anti-inflammatory drug may therefore manifest the same disorders towards other anti-inflammatories (even if different), precisely because the effect depends, as we have seen, not on the production of IgE towards a particular drug, but on the mechanism of action of this class of medicines. In any case, a careful evaluation by the allergist specialist will always be necessary and, if indicated, thecarrying out tests for exposure to NSAIDs in a hospital environment, to confirm any reactivity towards the suspected drug and identify it an alternative that is well tolerated. The diagnosis with the most well-known skin tests or blood tests are, in fact, unreliable for allergy to NSAIDs. For example, it is possible that a subject with adverse reactions to a drug that selectively inhibits Cox-1 can tolerate a selective (or partial) inhibitor of Cox-2, but the indication to take drugs must always be evaluated in the individual case by the allergist specialist, after carrying out any tests.
20 September 2023 (modified 20 September 2023 | 18:17)
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