Work

NSAID Tolerance Can Be Restored in NECD Even in the Absence of Complete Remission of Urticaria

Year: 2026

Type: article

Abstract: BACKGROUND/AIM: Data on the course of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity in NSAID-exacerbated cutaneous disease (NECD) are limited. We aimed to evaluate NSAID tolerance in NECD patients with well-controlled urticaria. METHODS: 142 patients with well-controlled urticaria [Urticaria Control Test (UCT) ≥ 12; Urticaria Activity Score over 7 days (UAS7) ≤ 6] underwent a single blind, placebo-controlled acetylsalicylic acid (ASA) provocation test. Patients were categorized into three groups based on their treatment; omalizumab, antihistamine, or no treatment. RESULTS: The median age of the patients was 40 years (IQR 31.5-52), and 79.6% were female. The median disease duration of chronic spontaneous urticaria (CSU) was 4 years (IQR 2-8). The ASA provocation test was positive in 29 patients (20.4%). Positive patients had lower UCT and higher UAS7 scores (both p < 0.001). ASA provocation test positivity was more common in the antihistamine group compared to both the omalizumab (p = 0.001) and untreated groups (p < 0.001). ROC analysis showed that UCT ≤ 15 predicted ASA provocation test positivity with 72.4% sensitivity and 83.2% specificity, while UAS7 ≥ 4 predicted positivity with 72.4% sensitivity and 86.7% specificity. The negative predictive values (NPV) were 92.2% and 92.5%, respectively. CONCLUSION: To our knowledge, this is the first study to demonstrate, in a large NECD cohort, that NSAID tolerance can be achieved in patients with well-controlled urticaria under different treatment modalities, regardless of complete remission status. UCT ≤ 15 and UAS7 ≥ 4 are useful clinical predictors of provocation test positivity and, given their high NPVs, are particularly valuable for excluding positivity.

Source: Clinical and Translational Allergy

DOI: 10.1002/clt2.70216