Allergic reactions to non-steroidal anti-inflammatory drugs: A retrospective clinical cohort analysis

The aim of this study was to examine the pathophysiological mechanisms, epidemiology, diagnostic strategies, and treatment approaches for non-steroidal anti-inflammatory drug (NSAID) allergy based on clinical data obtained in routine allergy practice. The study combined an analysis of the scientific literature with a retrospective clinical analysis of adult patients who presented to an allergy department with suspected NSAID hypersensitivity. Clinical data were derived from patient medical records and included documented reactions to NSAIDs, diagnostic procedures performed as part of standard care (medical history assessment, skin testing, laboratory investigations, basophil activation testing, and drug provocation tests), and applied therapeutic strategies. The clinical analysis identified two principal reaction mechanisms: immediate-type hypersensitivity mediated by IgE-dependent immune activation and immediate non-immunological hypersensitivity associated with cyclooxygenase-1 (COX-1) inhibition. Clinical manifestations ranged from cutaneous reactions to severe systemic responses, including anaphylaxis, as well as chronic conditions such as aspirin-exacerbated respiratory disease. The diagnostic value and practical limitations of the applied methods were evaluated in the clinical setting. Individualised management strategies, including avoidance of the causative NSAID, the use of alternative agents such as selective COX-2 inhibitors, pharmacological treatment of acute reactions, and desensitisation protocols, were summarised based on observed clinical practice. By integrating real-world clinical data with current scientific evidence, this study provides a clinically grounded overview of NSAID allergy and highlights the importance of personalised diagnostic and therapeutic approaches in everyday medical practice. The findings may be useful for allergists, immunologists, and general practitioners involved in the management of patients with suspected NSAID hypersensitivity.