Incidence and Clinical Characteristics of Nonsteroidal Anti-inflammatory Drugs (NSAIDS)-Induced Hypersensitivity Reactions: A Retrospective Cross-sectional Study

Surangrat Jaikong; Pranee Suecharoen; Surachai Sae-jung

doi:10.64960/srimedj.v41i2.269726

Authors

Surangrat Jaikong The Outpatient Drug Dispending Unit, Department of Pharmacy Services, Faculty of medicine, Khon Kaen University, KhonKaen 40002, Thailand
Pranee Suecharoen The Outpatient Drug Dispending Unit, Department of Pharmacy Services, Faculty of medicine, Khon Kaen University, KhonKaen 40002, Thailand
Surachai Sae-jung Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

DOI:

https://doi.org/10.64960/srimedj.v41i2.269726

Keywords:

nonsteroidal anti-inflammatory drugs, hypersensitivity reactions, NSAID-induced HSRs

Abstract

Background and objective: Widespread self-medication for minor pain has led to extensive use of nonsteroidal anti-inflammatory drugs (NSAIDs), sometimes for inappropriate indications, potentially increasing the risk of hypersensitivity reactions (HSRs). Real-world data on the incidence and clinical characteristics of NSAID-induced HSRs remain limited. This study aimed to estimate the incidence and characterize the clinical patterns of NSAID-induced HSRs at Srinagarind Hospital.

Methods: A retrospective cross-sectional study was conducted using electronic medical records from January 1, 2021, to December 31, 2023. Patients with documented immediate HSRs following NSAID exposure were identified. Causality was assessed using the Naranjo algorithm. Descriptive and inferential analyses were performed to estimate incidence and evaluate associations between NSAID type and reaction severity.

Results: Total of 1,349 patients with NSAID-associated HSRs were included; 70.5% were female, with a mean age of 51.96 ± 16.32 years. Ibuprofen accounted for the largest proportion of reactions (491, 36.40%), followed by diclofenac (254, 18.83%), naproxen (119, 8.82%), aspirin (97, 7.19%), and celecoxib (90, 6.67%). Most reactions were moderate (1,213, 89.90%), with severe events in 82 cases (6.07%). The majority were non-serious (1,232, 91.33%), with hospitalization in 70 cases (5.19%) and life-threatening reactions in 2 (0.14%). Causality was mainly classified as probable (685, 50.78%) or possible (649, 48.11%), while definite reactions were rare (14, 1.04%) and only one case (0.07%) was classified as doubtful. Cutaneous manifestations predominated, particularly rash and itching (24.54%) and angioedema (24.46%); anaphylaxis occurred in 82 cases (6.07%). Severe cutaneous adverse reactions were uncommon (SJS 0.44%, DRESS 0.29%, AGEP 0.29%). No significant associations were observed between NSAID type and reaction severity (p > 0.05).

Conclusions: NSAID-induced HSRs were predominantly moderate and non-serious. Ibuprofen was the most frequently implicated drug, followed by diclofenac and naproxen, underscoring the importance of vigilant monitoring and preventive strategies to reduce NSAID-related hypersensitivity.

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