NSAID-exacerbated cutaneous disease in CSU. Restriction is not the only option.

Published online: July 13, 2020

Non-Steroidal Anti-Inflammatory Drug (NSAID)-exacerbated cutaneous disease is a common comorbidity in patients with Chronic Spontaneous Urticaria (CSU), and the restriction of NSAIDs seems the only option. However, this solution has consequences when patients need a safe and effective alternative for pain or anti-inflammatory management.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Sánchez et al., questioned the need for NSAID restriction in all patients. Oral challenge tests with NSAIDs were performed in patients with NSAID-exacerbated cutaneous disease with CSU.  The authors confirmed some previous reports in that most patients who achieve clinical control of CSU using antihistamines, tolerate the use of NSAIDs. Therefore, they can use NSAIDs in case of analgesia or anti-inflammatory management.

The methodology of the article was simple but consistent: all patients had a diagnostic challenge with NSAIDs and then a challenge with NSAIDs while taking antihistamines. About 60% of the patients had no reaction with the NSAIDs if they were taking antihistamines. Therefore, NSAID restriction is not necessary.

This study represents the most complete evaluation available on this topic, and its results provide an alternative management for CSU patients with reactions to NSAIDs. Also, these findings have future implications: monitoring of disease activity and therapeutic response could predict patient tolerance to NSAIDs, which in turn should lead to changes in clinical guidelines.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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