Allergy/ Pseudoallergic to NSAIDS

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Allergy/ Pseudoallergic to NSAIDS

• ??????????? ????????????

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Cross - reactivity

• Cross reactivity ??????????????????????? immune
  system ???????????????????????????????????????????
  ????? ?????????????????????? ????
  ??????????????????????????????????????????????
  ???????????????????????????????? --gt
  Pseudoallergic
• Cross reactive allergic responses Immune
  response ??????????????? allergic molecule ?????
  ????????????????????????? molecule
  ????????????????????????????? --gt True allergy

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Case study 1
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Case study 1

• ???? 58 ?? ??????? ortho. ???????????????????????
  ? ??????????? Diclofenac 1x3 pc, Norgesic 1x3 pc,
  3B 1x3 pc ??? Losec 1x2 ac ???????????????????????
  ? pt. ????????????? med. ???????????????????
  ????? med. ??????????????? pt. ????????
  diclofenac inj. ????????????????? ?????
  ????????????????? ortho. ??????????????????????
  diclofenac ????? ortho.???????????????? naproxen
  ??? ?????? pt. ??????????????????????????
  diclofenac pt.????? naproxen ????????????????

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Case study 1
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Case study 1

• ???????????????????? pt. ?? admit ??????.
  ???????? ???????????????? ????? ??????????
  ??????????? ???????????? naproxen ???????? 1 ??.
  --gt ????????????????????????????? 0xygen ????????
  CPM inj., Dexa inj., CPM oral pt. admit ???? 2
  ??? ?????????????
• ?????????????
• Angioedema ??????????? naproxen

Cross reactivity
?????????
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Case study 1

• ???????????????????? ???. ?????? pt.
  ?????????????? 2 ????????????????????
  ?????????????????? pt. ????? aspirin ???
  diclofenac inj. ??????????????????????? ???
  ??????? ?????

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?????

• 1. pt.???????????????????????? ? ???? pt.
  ??????????????????????????????????????????????????
  ?
• 2. pt. ??????????????? 2 ?? ????????????????
  ??????????????????????????????????
• 3. ???????? True allergy ???? Pseudoallergic?

??????????????????? ?????????????????????????? ?
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Classification of NSAIDs
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Classification of NSAIDs (2)
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Classification of NSAIDs (3)
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Classification of NSAIDs (4)
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Classification of NSAIDs (5)
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Classification of NSAIDs (6)
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NSAIDs - Allergy

• True allergy --gt Immune mediated
• Pseudoallergic --gt Non - Immune mediated

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Pseudoallergic reactions

• ????Nonallergic hypersensitivity reaction

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Pseudoallergic reactions of Aspirin/ NSAIDs

• Respiratory diseases
• Rhinitis, nasal congestion,
• sinusitis, nasal polyp, asthma
• Urticaria/ Angioedema

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Aspirin NSAIDs induced Anaphylactoid/
Urticaria/ Angioedema/ Rhinitis/ Asthma

• ???????? Type I hypersensitivity
• Dose ??????????????????? ????????????? dose
  ?????????????????
• Skin test ??????????????????
• ???? Cross reaction ??????????????????????????????
  ?????? ???? Aspirin vs Ibuprofen

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Aspirin/ NSAIDsinducedrespiratory disease
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Aspirin NSAIDs induced Rhinitis/ Asthma

• ???????????????????? ???????????? 30 ??
• ??????????????? aspirin/ NSAIDs
  ?????????????????????????????
• ????????????????? (??????? ?????????)
  ?????????????????????? 3 ????? 5 ?? (????????
  aspirin/ NSAIDs ???????????????????????????????
  rhinitis/ nasal congestion/ nasal polyp/ asthma
  ???)
• ??????? 15 20 ????????????????
  ????????????????????????????? 3 ???

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???? Cox 1 inh. ?????????????? Cox 2 inh.

• Cox 1 ????? respiratory tract, GI tract ???
  inflammatory cells ????????????????? ??? Cox 2
  ?????????? inflammatory cells
• ??????? Cox 1 inhibitor ???????????????????
  PGE2 ???????? stability ??? membrane mast
  cells/ eosinophil ???? ???????? histamine ???
  mediators ????????? --gt bronchoconstrict,
  urticaria, angioedema, asthma
• ??????? Cox 2 inhibitor ???????????????????
  PGE2 ??????? --gt ???????????????
  bronchoconstrict, urticaria, angioedema, asthma

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Ex. Of NSAIDs to be avoided in aspirin
sensitive asthma patients

• Diflunisal
• Indomethacin
• Ketorolac
• Meloxicam (preferential Cox 2)
• Piroxicam
• Tenoxicam

• Diclofenac
• Ibuprofen
• Ketoprofen
• Mefenamic acid
• Naproxen
• Phenylbutazone
• Sulindac
• Tiaprofenic acid

Cox 1 precipitate asthma Cox 2 may not
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Aspirin/ NSAIDsinducedUrticaria/Angioedema
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Case study 2

• Pt. ????????? ASA 60 mg OD ?????????? 2 ??
  ????????????????
• ???????? Pt. admit ER ????????????????????????????
  ?????????????????????????????????????
• ?????????????????? Aspirin 325 --gt urticaria,
  angioedema
• Pseudoallergic - ???????????????????

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Aspirin/ NSAIDs inducedUrticaria/Angioedema
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Substituted medications-Aspirininduced urticaria
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Substituted medications-Aspirininduced urticaria
(2)
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Substituted medications-Aspirininduced urticaria
(3)
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Case study 1
Aspirin
Diclofenac Sodium
Naproxen
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Case study 3
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Case study 3

• ??? 45 ?? ??????? ??? naproxen ??? 10
  ??????????????????????????? ??????????????????
• 3 ????????? ?????? naproxen ??? 7 ??? ??????????
• ???????????? asthma, nasal polyp
• ????? --gt True allergy/ Pseudoallergic ?

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• ??????? True allergy
• ????????????? --gt ???????????? Ab ????????? Ab
  ??????????????????????????????????? ???????????
• ????????????? 2 -gt ?? Ab ?????????????????????????
  ?????????
• ??????? Pseudoallergic
• ????????????????????????????????
• Challenge -gt ??? ASA ???? Diclofenac
  ???????????
• ???????????????? ASA ??? diclofenac ?????????
• True allergy -gt ??????? naproxen
  ???????????????????????????

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?????????? naproxen ????????? ??? NSAIDs ???????
??????????? propionic acid
Ketoprofen
Ibuprofen
Naproxen
Fenoprofen
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Case study 4

• ??? Brufen ???? urticaria
• ????????????????????????????????? ?
• ????????????? Celecoxib ?????????? Cox I
  inhibitor ?????????? ?
• ???????????? naproxen ??? ibuprofen
  ?????????????? ?
• True allergy/ Pseudoallergic ?

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Case study 4

• True allergy
• ??? Naproxen -gt ???? urticaria
• ??? Diclofenac -gt ??????? urticaria
• Pseudoallergic
• ??? Naproxen -gt ???? urticaria
• ??? Diclofenac -gt ???? urticaria
• Case ?????? brufen ?? urticaria ?????? diclofenac
  ??? --gt True allergy

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Case study 4
Naproxen
Ibuprofen
Diclofenac Sodium
Piroxicam
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Aspirin Desensitization forPseudoallergic
Reactions (Aspirin induced rhinitis/
asthmaurticaria/ angioedema)
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