NSAID Tolerance Can Be Restored in NECD Even in the Absence of Complete Remission of Urticaria
Merve Hormet Igde, Pelin Korkmaz, Semra Demir, Osman Ozan Yegit, Derya Ünal, Merve Dilşad Atasever, Ayşe Feyza Aslan, Leyla Bölek, Selin Ece Güzel, Nevzat Kahveci, Mehmet Emin Sezgin, Şule Çelik Kamacı, Esra Kaya, Bircan Erden, Asli GelincikABSTRACT
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.