Real-Life Outcomes of Oral Provocation Testing with Alternative NSAIDs in NSAID Hypersensitivity

Öz

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common causes of drug hypersensitivity reactions. Identifying safe alternative NSAIDs through oral provocation testing (OPT) is essential for clinical management. The 2025 World Allergy Organization (WAO) classification introduced updated phenotypes, highlighting the need for real-life data on tolerated alternative agents. Materials and methods: This retrospective study included 824 adults evaluated for suspected NSAID hypersensitivity between January 2020 and September 2025. Patients were reclassified according to the 2025 WAO criteria. Demographic characteristics, comorbid allergic diseases, culprit drugs, laboratory parameters, and outcomes of OPT with alternative NSAIDs were analyzed. Results: The mean age was 44.7 ± 13.2 years, and 65.5% of patients were female. According to the 2025 WAO classification, 48.8% had NSAID-exacerbated cutaneous disease (NECD), 32.2% NSAID-induced urticaria/angioedema (NIUA), and 11.2% single NSAID-induced urticaria/angioedema/anaphylaxis (SNIUAA). Among 704 patients undergoing OPT, tolerance rates were high for meloxicam (96%), nimesulide (97%), and celecoxib (98.6%). The distribution of asthma, rhinitis, urticaria/angioedema, chronic sinusitis, and nasal polyps differed significantly among WAO phenotypes (p < 0.05), whereas tolerance to alternative NSAIDs did not differ between groups (p > 0.05). Conclusion: Meloxicam, nimesulide, and celecoxib are well tolerated in most patients with NSAID hypersensitivity. The 2025 WAO classification improves phenotypic stratification, while OPT remains a reliable method for identifying safe alternative NSAIDs in real-life practice.

Anahtar Kelimeler

• Nonsteroidal anti-inflammatory drugs
• drug hypersensitivity
• oral provocation test
• meloxicam
• celecoxib

NSAİİ Aşırı Duyarlılığında Alternatif NSAİİ’lerle Oral Provokasyon Testinin Gerçek Yaşam Sonuçları

Öz

Amaç: Nonsteroid antiinflamatuvar ilaçlar (NSAİİ), ilaç aşırı duyarlılık reaksiyonlarının en sık nedenleri arasında yer almaktadır. Güvenli alternatif NSAİİ’lerin belirlenmesinde oral provokasyon testi (OPT) klinik yönetim açısından büyük önem taşımaktadır. 2025 Dünya Alerji Organizasyonu (WAO) sınıflamasında güncellenen fenotip tanımlamaları, gerçek yaşam verilerine olan ihtiyacı artırmıştır. Bu çalışmada, NSAİİ aşırı duyarlılığı olan hastalarda alternatif NSAİİ’lerle yapılan OPT sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif çalışmaya Ocak 2020–Eylül 2025 tarihleri arasında NSAİİ aşırı duyarlılığı şüphesiyle değerlendirilen 824 erişkin hasta dahil edildi. Hastalar 2025 WAO sınıflamasına göre yeniden sınıflandırıldı. Demografik özellikler, eşlik eden alerjik hastalıklar, sorumlu ilaçlar, laboratuvar bulguları ve alternatif NSAİİ’lerle yapılan oral provokasyon testlerinin sonuçları analiz edildi. Bulgular: Hastaların ortalama yaşı 44,7 ± 13,2 yıl olup, %65,5’i kadındı. 2025 WAO sınıflamasına göre hastaların %48,8’i NSAİİ ile alevlenen kutanöz hastalık (NECD), %32,2’si NSAİİ ile indüklenen ürtiker/anjiyoödem (NIUA) ve %11,2’si tek NSAİİ ile indüklenen ürtiker/anjiyoödem/anafilaksi (SNIUAA) grubunda yer aldı. Oral provokasyon testi uygulanan 704 hastada meloksikam (%96), nimesulid (%97) ve selekoksib (%98,6) için yüksek tolerans oranları saptandı. Astım, rinit, ürtiker/anjiyoödem, kronik sinüzit ve nazal polip sıklıkları WAO fenotipleri arasında anlamlı farklılık gösterirken (p < 0,05), alternatif NSAİİ’lere tolerans oranları gruplar arasında benzerdi (p > 0,05). Sonuç: Meloksikam, nimesulid ve selekoksib, NSAİİ aşırı duyarlılığı olan hastaların büyük çoğunluğunda iyi tolere edilmektedir. 2025 WAO sınıflaması fenotipik ayrımı güçlendirirken, oral provokasyon testi gerçek yaşam pratiğinde güvenli alternatif NSAİİ’lerin belirlenmesinde güvenilir bir yöntem olmaya devam etmektedir.

Anahtar Kelimeler

• Nonsteroid antiinflamatuvar ilaçlar
• NSAİİ aşırı duyarlılığı
• Oral provokasyon testi
• Meloksikam
• Selekoksib

Kaynakça

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