The following is a summary of “Evaluation and Updated Classification of Acute Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAID-Exacerbated or -Induced Food Allergy,” published in the June 2023 issue of Allergy and Clinical Immunology by Romano et al.

Hypersensitivity reactions (HRs) to foods where nonsteroidal anti-inflammatory drugs (NSAIDs) function as aggravating factors or cofactors are frequently misdiagnosed as HRs to NSAIDs. The classification criteria for urticarial/angioedematous and anaphylactic reactions to two or more chemically unrelated NSAIDs are unmet. NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis may be considered a cross-reactive type of acute HR. The purpose is to classify patients who report acute HRs to NSAIDs based on updated criteria after evaluating patients who report sharp HRs. 

Researchers studied 414 patients with suspected HRs to NSAIDs prospectively. NEFA/NIFA was diagnosed in all individuals who met the following criteria: mild reactions to (NEFA) or tolerance of (NIFA) the suspected foods without taking NSAIDs; cutaneous and anaphylactic reactions to the combination foods plus NSAIDs; positive allergy tests to the suspected foods; and opposing drug challenges (DCs) with the NSAIDs involved. The diagnosis of NSAID hypersensitivity was given to 252 patients (60.9%), 108 of whom had NSAID-induced urticaria/angioedema with or without respiratory or systemic symptoms of anaphylaxis. 

They ruled out NSAID hypersensitivity in 162 patients (39.1%) who tolerated DCs containing the suspected NSAIDs; nine were diagnosed with NEFA and 66 with NIFA. Pru p 3 was associated with 67 of the 75 patients diagnosed with NEFA or NIFA. NEFA and NIFA account for approximately 18% of patients reporting HRs to NSAIDs, with Pru p 3 being the primary food allergen implicated. Therefore, patients with cutaneous and anaphylactic reactions to NSAIDs should be carefully questioned about all foods consumed within 4 hours before or following NSAID exposure. Targeted food allergy tests should be considered as part of their diagnostic workup. If testing is positive, consideration should also be given to DCs containing the suspected NSAIDs.

Source: sciencedirect.com/science/article/abs/pii/S221321982300346X