Allergic Reactions to NSAIDs during Febrile States: Case Report and Review of the Literature

The high frequency of allergic reactions (AR) to non-steroidal anti-inflammatory drugs (NSAID) has been linked to their extensive usage, resulting in adverse reactions that affect various systems and organs. This literature review, initiated by a case report of an immediate rash following NSAID administration for fever reduction, explores the possible mechanisms that drive such reactions. The results indicate that, in certain instances, NSAIDs can induce ARs specifically in the presence of an inflammatory febrile response following viral infections through a complex interaction of similar mechanisms. This intricate process involves the activation of proallergic-pyrogenic mediators like complement factor C5a, IL-1 β and IL-6, and TNF-α, in addition to the modulation of immune cells through specific signal pathways. Moreover, factors such as compromised skin barrier function in some severe skin ARs, and the activation of memory CD4+ T helper 2 cells by TNF-family molecules, contribute to the emergence of ARs in reaction to NSAID exposure during a febrile condition. This case report underscores the significance of thoroughly reviewing the patient’s medical history to ensure safe treatment. Meanwhile, the transient drug hypersensitivity reactions necessitate further exploration for a comprehensive understanding of the underlying mechanisms.