A new classification of aspirin sensitivity conditions

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European experts have just published a new classification of aspirin sensitivity conditions. According to this paper, pathologies involving aspirin/NSAIDs sensitivity are now classified into 5 categories : Conditions 1-4 are immediate (reaction within 24h of contact/ingestion), while condition 5 is delayed (reaction after 24h, even weeks after).1- Aspirin-exacerbated respiratory diseases (AERDs), which includes all respiratory conditions created or worsened by NSAIDs.2- Aspirin-exacerbated urticaria/angioedema, in which an existing chronic urticaria is exacerbated by NSAIDs.3- Multiple-NSAID-induced urticaria/angioedema, in which a previously inexistent urticaria/angioedema is created by NSAIDs.4 - Single-NSAID-induced reactions, in which only one type of NSAID created a reaction. This pathology is likely to be IgE-mediated, whereas the first 3 are cyclooxygenase-mediated.5 - Delayed reactions.Note that a patient may have more than one condition (e.g. 1+2 or 1+3).Regarding AERD, the definition that is now proposed is the following : Definition

The coexistence of hypersensitivity to aspirin (and to other NSAIDs) with upper airway (rhinosinusitis/nasal polyps) and lower airway (asthma) disease was referred to as aspirin triad, asthma triad, Widal's syndrome, Samter's syndrome, aspirin-induced asthma, aspirin intolerant asthma or aspirin- sensitive rhinosinusitis/asthma syndrome (17). More recently, the term aspirin-exacerbated respiratory disease (AERD) was proposed stressing the fact that the core issue in these patients is not drug hypersensitivity, but the underlying chronic inflammatory respiratory disease only occasionally exacerbated by aspirin or other NSAIDs ------------------------------Allergy. 2011 Jul;66(7):818-829. doi: 10.1111/j.1398-9995.2011.02557.x. Epub 2011 Feb 14.Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA(#) and GA2LEN/HANNA*Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bousquet J, Bousquet P, Celik G, Demoly P, Gomes ER, Niżankowska-Mogilnicka E, Romano A, -Borges M, Sanz M, MJ, De Weck A, Szczeklik A, Brockow K.SourceDepartment of Immunology, Rheumatology and Allergy, Medical University of Lodz, Poland Allergy Serivice, Haya Hospital, Malaga, Spain Department of Allergy, Ankara University School of Medicine, Ankara, Turkey Department of Respiratory Diseases Jagiellonian University, Krakow, Poland Exploration des Allergies, CHU Montpellier and INSERM U780, Montpellier BESPIM, GHU Caremeau, CHU Nimes, 30029 Nimes, France & Exploration des Allergies, CHU Montpellier, Montpellier Exploration des allergies and INSERM U657, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France Department of Allergy, Hospital Pediatrico Pia, Porto, Portugal Department of Internal Medicine and Geriatrics, USCS-Allergy Unit, Complesso Integrato Columbus, Rome, Italy Department of Allergy and Immunology, Centro Médico-Docente La Trinidad, Caracas, Venezuela Department of Allergology and Clinical Immunology. Clínica Universidad de Navarra, Pamplona, Spain Department of Internal Medicine, Jagiellonian University, Krakow, Poland Department of Dermatology und Allergology Biederstein and Division Environmental Dermatology and Allergology Helmholtz Zentrum Munchen/TUM, Technical University Munich, Munich, Germany.AbstractTo cite this article: Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bousquet J, Bousquet P, Celik G, Demoly P, Gomes ER, Niżankowska-Mogilnicka E, Romano A, -Borges M, Sanz M, MJ, De Weck A, Szczeklik A, Brockow K. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: Review of the EAACI/ENDA and GA2LEN/HANNA. Allergy 2011; 66: 818-829. ABSTRACT: Nonsteroidal anti-inflammatory drugs (NSAIDs) are responsible for 21-25% of reported adverse drug events which include immunological and nonimmunological hypersensitivity reactions. This study presents up-to-date information on pathomechanisms, clinical spectrum, diagnostic tools and management of hypersensitivity reactions to NSAIDs. Clinically, NSAID hypersensitivity is particularly manifested by bronchial asthma, rhinosinusitis, anaphylaxis or urticaria and variety of late cutaneous and organ-specific reactions. Diagnosis of hypersensitivity to a NSAID includes understanding of the underlying mechanism and is necessary for prevention and management. A stepwise approach to the diagnosis of hypersensitivity to NSAIDs is proposed, including clinical history, in vitro testing and/or provocation test with a culprit or alternative drug depending on the type of the reaction. The diagnostic process should result in providing the patient with written information both on forbidden and on alternative drugs.© 2011 Wiley & Sons A/S.PMID: 21631520 [PubMed - as supplied by publisher]