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Diagnostic challenge and desensitization protocols for NSAID reactions

Ronald A Simon, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD


Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, can cause several distinct types of allergic and pseudoallergic reactions. These reactions are categorized by the presumed underlying mechanism and whether the reaction is elicited by multiple NSAIDs or by a single agent. Challenge procedures are used in the diagnosis of some NSAID reactions, and desensitization protocols are used in management of patients who require NSAID therapy despite a history of adverse reactions.

The various challenge and desensitization protocols used by allergy specialists will be reviewed here. The clinical features of NSAID reactions and the use of alternative medications, either medications that are highly selective inhibitors of the enzyme cyclooxygenase-2 (COX-2) (eg, celecoxib, others) or NSAIDs that weakly inhibit cyclooxygenase-1 (COX-1), are presented elsewhere. (See "NSAIDs (including aspirin): Allergic and pseudoallergic reactions".)


To determine if a diagnostic challenge and/or desensitization is appropriate for a patient with a history of NSAID reaction, the clinician must first attempt to classify the patient's past reaction. This is done by reviewing the clinical history in detail. The most important elements of the history are:

The signs and symptoms of the reaction

Whether the reaction has been elicited by a single NSAID or multiple NSAIDs

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Literature review current through: Nov 2017. | This topic last updated: Apr 25, 2017.
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