Patients who know they’re allergic to NSAIDs still take dangerous chances
Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofin, or naproxen, are used daily by many people, however hypersensitivity to these drugs is a common problem. For those allergic to NSAIDs, tests are done to identify alternative medications to reduce their risk for allergic reactions, and people with drug hypersensitivities are encouraged to carry medical identification cards that list all allergies (sometimes called an allergy ID). There is, though, limited data on long-term compliance with drug avoidance of NSAIDs by hypersensitive patients, their satisfaction with alternative medications, and the quality of their consultations with allergy specialists.
In a study published in the January 2011 issue of The Journal of Allergy and Clinical Immunology (JACI), German researchers Buhl and colleagues analyze the results from a follow-up of patients in an allergy study who had been identified as NSAID-sensitive 4-7 years earlier. Eighty of the original 229 study patients participated in the follow-up phase.
The authors found that 33 of the 80 participants admitted they had taken the NSAID to which they were hypersensitive after their last appointment at the allergy clinic. Twenty-two patients stated it was an accidental intake, while 11 had taken the NSAID intentionally; after the accidental exposures, 4 had severe anaphylactic reactions, 11 had mild reactions, and 4 reported no reactions. Only 45% of the patients could remember several years after diagnosis which alternative drugs were safe for them to take and remembered their specialist’s advice about their NSAID hypersensitivity. Sixty-one (76%) of the participants reported that they always carried their allergy ID card. Fifty-one participants had taken alternative drugs and 78% of these patients were satisfied with their alternative medication.
These findings show that many patients with hypersensitivities to NSAIDS are exposed to these drugs accidentally, some even intentionally. Accidental exposure can occur when particular care is not taken to read what compounds are in multiple-agent drugs, or if physicians are not aware of a patient’s previous hypersensitivity reaction.
The authors state that their findings demonstrate a need to improve patients’ understanding of their allergies, educating them in lay terms about disease mechanisms, emergency treatments, allergy IDs and available alternative drugs. The authors propose that patients have at least 1 follow-up appointment with an allergy specialist one year after hypersensitivity diagnosis, with the hope that this would reduce accidental or intentional re-exposure. In addition to more careful patient education, these researchers recommend improving identification of patients who are at risk for re-exposure (those with chronic pain conditions, insufficient alternative drugs, or psychosocial problems) to raise quality of care and increase patients’ adherence to allergists’ recommendations.
The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.