D1.365 - Long-term course of NSAID tolerance in patients with cross-hypersensitivity presenting with respiratory symptoms

While most patients (over 60%) who suffer from urticaria/angioedema induced by cross-hypersensitivity to non-steroidal anti-inflammatory drugs (CHS-NSAIDs) eventuallybecome tolerant,  data on how such tolerance develops in patients with CHS-NSAIDs involving respiratory symptoms (RS) are lacking. Therefore, our study aimed to assess NSAID-tolerance  acquisition in patients with RS alone or combined with skin involvement.

Patients initially confirming their hypersensitivity in 2016 by positive lysine-acetylsalicylate nasal provocation test (LASA-NPT) or oral provocation test (OPT) to aspirin (ASA) were included. They were re-evaluated in 2020 and 2024 with LASA-NPT and, if negative, with OPT with ASA and other culprit NSAIDs. Subjects with severe asthma or receiving biological agents were excluded.

Out of the 57 subjects included, 28 reported rhinitis/asthma and 29 both rhinitis/asthma and urticaria/angioedema. During the follow-up period, 16 tolerated ASA and other NSAIDs (28.1%; Group A), while 41 continued to react (71.9%; Group B). Besides, 68.4% had underlying rhinitis: intermittent in 92.3% in Group A and persistent in 78.8% in Group B (p<0.0001); and 52.6% had underlying asthma (63.4% in Group B  versus 25% in Group A; p=0.009). All cases in Group A had mild intermittent asthma, whereas 31.7% in Group B had mild intermittent asthma, and 36.6% moderated persistent (p=0.002). From the total cohort, 21% had nasosinusal polyposis and 61.4% atopy (no differences between groups). Similarly, no differences were found when comparing reported symptoms or last reaction-allergological study interval in both groups.

NSAID-tolerance acquisition in patients with CHS-RS is closely tied to the severity of their underlying respiratory disease. Inflammatory biomarkers characterisation could help to predict the optimal timing for patient re-evaluation, preventing unnecessary NSAID avoidance.