NSAIDs are the most commonly implicated medications in hypersensitivity responses (HSR). HSR is a major problem that may impact people of any age. These medications can cause responses by activating the adaptive immune system (IgE or T cells), which are known as selective responders, or by causing anomalies in metabolic pathways associated with prostaglandin metabolism, which is more common. These are referred to as cross-intolerant. Several categories have been proposed in recent years, depending on clinical symptoms, time gap between medication consumption and onset of symptoms, responsiveness to other non chemically related NSAIDs, and the underlying illness. Based on this categorization, many distinct kinds of cross-intolerant and selective responders are currently recognised within each category of entities. Cross-intolerant patients are the most difficult to assess since they have three primary groups: NSAIDs worsen respiratory disease, NSAIDs exacerbated cutaneous disease, and NSAIDs-induced urticaria/angioedema in the absence of persistent spontaneous urticaria. There are two processes at work in selective responders: drug-specific IgE and T-cell effector responses. This categorization has been expanded to include new entities such as mixed responses within the cross-intolerant group, which must present as anaphylaxis and numerous acute selective reactions.

The accurate evaluation of patients with NSAID hypersensitivity in accordance with established criteria would enhance not only the understanding but also the management of these entities. Because the number of people impacted by NSAIDs is significant, more research is needed.

Reference: https://journals.lww.com/co-allergy/Abstract/2018/08000/NSAIDs_hypersensitivity__questions_not_resolved.4.aspx