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Reigada-Rivera ML, Lozano CS, Rodilla EM, García-Sánchez A, García-Solaesa V, Toledano FL, González ID, Isidoro-García M. Polymorphisms in Human IL4, IL10, and TNF Genes Are Associated with an Increased Risk of Developing NSAID-Exacerbated Respiratory Disease. Genes (Basel) 2022; 13:genes13040605. [PMID: 35456412 PMCID: PMC9031626 DOI: 10.3390/genes13040605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The role of genetics in non-steroidal anti-inflammatory drugs (NSAID) exacerbated respiratory disease (NERD) is unclear, with different candidates involved, such as HLA genes, genes related to leukotriene synthesis, and cytokine genes. This study aimed to determine possible associations between 22 polymorphisms in 13 cytokine genes. Methods: We included 195 patients (85 with NERD and 110 with respiratory disease who tolerate NSAIDs) and 156 controls (non-atopic individuals without a history of asthma, nasal polyposis (NP), or NSAID hypersensitivity). Genotyping was performed by sequence-specific primer polymerase chain reaction (PCR-SSP). Amplicons were analyzed by horizontal gel electrophoresis in 2% agarose. Results: Significant differences in allele and genotype frequency distributions were found in TNF (rs1800629), IL4 (rs2243248 and rs2243250), and IL10 (rs1800896, rs1800871, and rs1800872) genes in patients with NSAID hypersensitivity. In all cases, the minor allele and the heterozygous genotype were more prevalent in NERD. An association of TNF rs1800629 SNP with respiratory disease in NSAID-tolerant patients was also found. Conclusions: Retrospectively recorded, we found strong associations of NERD with polymorphisms in IL4, IL10, and TNF genes, suggesting that these genes could be involved in the inflammatory mechanisms underlying NERD.
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Affiliation(s)
- María Luisa Reigada-Rivera
- Department of Clinical Biochemistry, University Hospital of Salamanca, 37007 Salamanca, Spain; (M.L.R.-R.); (V.G.-S.); (M.I.-G.)
- Biomedical Research Institute of Salamanca IBSAL, 37007 Salamanca, Spain; (E.M.R.); (A.G.-S.); (F.L.T.)
| | - Catalina Sanz Lozano
- Biomedical Research Institute of Salamanca IBSAL, 37007 Salamanca, Spain; (E.M.R.); (A.G.-S.); (F.L.T.)
- Department of Microbiology and Genetics, University of Salamanca, 37007 Salamanca, Spain
- Correspondence: (C.S.L.); (I.D.G.)
| | - Esther Moreno Rodilla
- Biomedical Research Institute of Salamanca IBSAL, 37007 Salamanca, Spain; (E.M.R.); (A.G.-S.); (F.L.T.)
- Department of Allergy, University Hospital of Salamanca, 37007 Salamanca, Spain
- Department of Biomedical Sciences and Diagnostics, University of Salamanca, 37007 Salamanca, Spain
| | - Asunción García-Sánchez
- Biomedical Research Institute of Salamanca IBSAL, 37007 Salamanca, Spain; (E.M.R.); (A.G.-S.); (F.L.T.)
- Department of Biomedical Sciences and Diagnostics, University of Salamanca, 37007 Salamanca, Spain
| | - Virginia García-Solaesa
- Department of Clinical Biochemistry, University Hospital of Salamanca, 37007 Salamanca, Spain; (M.L.R.-R.); (V.G.-S.); (M.I.-G.)
- Biomedical Research Institute of Salamanca IBSAL, 37007 Salamanca, Spain; (E.M.R.); (A.G.-S.); (F.L.T.)
| | - Félix Lorente Toledano
- Biomedical Research Institute of Salamanca IBSAL, 37007 Salamanca, Spain; (E.M.R.); (A.G.-S.); (F.L.T.)
- Department of Biomedical Sciences and Diagnostics, University of Salamanca, 37007 Salamanca, Spain
- Department of Pediatrics, University Hospital of Salamanca, 37007 Salamanca, Spain
| | - Ignacio Dávila González
- Biomedical Research Institute of Salamanca IBSAL, 37007 Salamanca, Spain; (E.M.R.); (A.G.-S.); (F.L.T.)
- Department of Allergy, University Hospital of Salamanca, 37007 Salamanca, Spain
- Department of Biomedical Sciences and Diagnostics, University of Salamanca, 37007 Salamanca, Spain
- Correspondence: (C.S.L.); (I.D.G.)
| | - María Isidoro-García
- Department of Clinical Biochemistry, University Hospital of Salamanca, 37007 Salamanca, Spain; (M.L.R.-R.); (V.G.-S.); (M.I.-G.)
- Biomedical Research Institute of Salamanca IBSAL, 37007 Salamanca, Spain; (E.M.R.); (A.G.-S.); (F.L.T.)
- Department of Medicine, University of Salamanca, 37007 Salamanca, Spain
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Blanca-Lopez N, Soriano V, Garcia-Martin E, Canto G, Blanca M. NSAID-induced reactions: classification, prevalence, impact, and management strategies. J Asthma Allergy 2019; 12:217-233. [PMID: 31496752 PMCID: PMC6690438 DOI: 10.2147/jaa.s164806] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/03/2019] [Indexed: 12/20/2022] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the leading cause of hypersensitivity drug reactions. The different chemical structures, cyclooxygenase 1 (COX-1) and/or COX-2 inhibitors, are taken at all ages and some can be easily obtained over the counter. Vasoactive inflammatory mediators like histamine and leukotriene metabolites can produce local/systemic effects. Responders can be selective (SR), IgE or T-cell mediated, or cross-intolerant (CI). Inhibition of the COX pathway is the common mechanism in CI, with the skin being the most frequent organ involved, followed by the lung and/or the nose. An important number of cases have skin and respiratory involvement, with systemic manifestations ranging from mild to severe anaphylaxis. Among SR, this is the most frequent entity, often being severe. Recent years have seen an increase in reactions involving the skin, with many cases having urticaria and/or angioedema in the absence of chronic urticaria. Aspirin, the classical drug involved, has now been replaced by other NSAIDs, with ibuprofen being the universal culprit. For CI, no in vivo/in vitro diagnostic methods exist and controlled administration is the only option unless the cases evaluated report repetitive and consistent episodes with different NSAIDs. In SR, skin testing (patch and intradermal) with 24-48 reading can be useful, mainly for delayed T-cell responses. Acetyl salicylic acid (ASA) is the test drug to establish the diagnosis and confirm/exclude CI by controlled administration. Desensitization to ASA has been extensively used in respiratory cases though it can also be applied in those cases where it is required.
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Affiliation(s)
| | - Victor Soriano
- General University Hospital of Alicante-ISABIAL
, Alicante, Madrid, Spain
| | - Elena Garcia-Martin
- Medical and Surgery Therapy Department, University of Extremadura, Caceres, Spain
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Abstract
PURPOSE OF REVIEW NSAIDs are the drugs most frequently involved in hypersensitivity reactions (HSR). These are frequently prescribed at all ages. HSR are of great concern and can affect people at any age. These drugs can induce reactions by stimulating the adaptive immune system (IgE or T cell), known as selective responders or more frequently by abnormalities in biochemical pathways related with prostaglandin metabolism. These are known as cross-intolerant. With some exceptions, skin testing and in-vitro studies are of little value in selective responders. RECENT FINDINGS In the last years, several classifications have been provided based on clinical symptoms, time interval between drug intake and appearance of symptoms, response to other nonchemically related NSAIDs and the underlying disease. Based on this classification, several well differentiated categories within each group of entities cross-intolerant and selective responders are now recognized. The most complex groups for evaluation are cross-intolerant in which three major groups exist: NSAIDs exacerbated respiratory disease, NSAIDs exacerbated cutaneous disease and NSAIDs-induced urticaria/angioedema in the absence of chronic spontaneous urticaria. Within the selective responders, there are two mechanisms involved: drug-specific IgE or T-cell effector responses. New entities have been added to this classification like mixed reactions within the cross-intolerant category, that must manifest as anaphylaxis and multiple immediate selective reactions. SUMMARY The precise evaluation of patients with NSAIDs hypersensitivity following established guidelines will improve not only our understanding but also the management of these entities. As the number of patients affected with NSAIDs is important, further studies are warranted.
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Pérez-Sánchez N, Jurado-Escobar R, Doña I, Soriano-Gomis V, Moreno-Aguilar C, Bartra J, Isidoro-García M, Torres MJ, Cornejo-García JA. Pharmacogenomics as a Tool for Management of Drug Hypersensitivity Reactions. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-0199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Blanca-Lopez N, Perez-Alzate D, Canto G, Blanca M. Practical approach to the treatment of NSAID hypersensitivity. Expert Rev Clin Immunol 2017; 13:1017-1027. [PMID: 28893093 DOI: 10.1080/1744666x.2017.1377072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently involved in drug hypersensitivity reactions (DHR). NSAIDs are prescribed for different processes and some NSAIDs can be obtained over the counter. Areas covered: We analyse the practical approaches for managing and treating NSAID-DHR considering the five major groups of entities recognised, divided into two categories: those responding to strong COX-1 inhibitors and possibly weak COX-1 or selective COX-2 inhibitors named cross-intolerant (CI), and those induced by a single drug or drug group with good tolerance to strong COX-1 inhibitors, known as allergic reactions (SR). An analysis of the recent literature indicates that two approaches can be followed for CI: to give acetyl salicylic acid to confirm NSAID hypersensitivity or to give alternative drugs to provide a solution for the treatment of pain, fever, inflammation or other conditions. Desensitisation approaches have been undertaken, but mainly for CI cases with respiratory airway involvement and they are very rarely used for CI with cutaneous involvement or SR. Expert commentary: DHR to NSAIDs are now recognised as one of the most important problems in the evaluation and management of drug allergy. Because no diagnostic tests exist, important resources are needed to evaluate these patients.
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Affiliation(s)
| | | | - Gabriela Canto
- a Allergy Service , Hospital Infanta Leonor , Madrid , Spain
| | - Miguel Blanca
- a Allergy Service , Hospital Infanta Leonor , Madrid , Spain
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Aktuelle Diagnostik der NSAR-Überempfindlichkeit. ALLERGO JOURNAL 2017. [DOI: 10.1007/s15007-017-1434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Doña I, Barrionuevo E, Salas M, Cornejo-García JA, Perkins JR, Bogas G, Prieto A, Torres MJ. Natural evolution in patients with nonsteroidal anti-inflammatory drug-induced urticaria/angioedema. Allergy 2017; 72:1346-1355. [PMID: 28226401 DOI: 10.1111/all.13147] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent triggers of drug hypersensitivity with NSAIDs-induced urticaria/angioedema (NIUA) the most common phenotype. Loss of hypersensitivity has been reported for IgE-mediated reactions; however, it has not been assessed in nonimmunological reactions such as NIUA. We evaluated NSAID-hypersensitivity over time in NIUA patients. METHODS Patients confirmed as NIUA by positive drug provocation test (DPT) with acetylsalicylic acid (ASA) during 2005-2012 (V1) were included (n=38). Subjects were prospectively re-evaluated by DPT with ASA/other NSAIDs at two time points between 2013 and 2015 (V2 and V3). Atopy was assessed by skin prick test (SPT) using inhalant and food allergens. RESULTS Patients were evaluated at V1 and re-evaluated after 60 months (V2; IR:48-81) and a further 18 months (V3; IR:14-24). At V2, the majority (24; 63.15%) tolerated ASA and other NSAIDs (Group A) while 14 (36.84%) still reacted (Group B). At V3, all Group A patients remained tolerant; all Group B patients remained hypersensitive. The number of previous episodes reported at V1 and the percentage of reactions induced by ASA/ibuprofen were significantly lower in Group A (P=.005 and P=.006, respectively). Group A patients developed tolerance 72 months (IR:45-87) after their last evaluated reaction (V1); this interval was shorter in nonatopics (P=.003), patients who experienced reactions over 1 hour after NSAIDs administration (P=.001), and those who experienced isolated urticaria after NSAID intake (P=.024). CONCLUSIONS NIUA patients may develop tolerance to NSAIDs over time, a process that seems to be influenced by atopy and type of clinical reaction.
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Affiliation(s)
- I. Doña
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - E. Barrionuevo
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - M. Salas
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - J. A. Cornejo-García
- Research Laboratory; IBIMA-Regional University Hospital of Malaga-UMA; Malaga Spain
| | - J. R. Perkins
- Research Laboratory; IBIMA-Regional University Hospital of Malaga-UMA; Malaga Spain
| | - G. Bogas
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - A. Prieto
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - M. J. Torres
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
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Böhm R, Cascorbi I. Pharmacogenetics and Predictive Testing of Drug Hypersensitivity Reactions. Front Pharmacol 2016; 7:396. [PMID: 27818635 PMCID: PMC5073094 DOI: 10.3389/fphar.2016.00396] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/07/2016] [Indexed: 12/15/2022] Open
Abstract
Adverse drug reactions adverse drug reaction (ADR) occur in approximately 17% of patients. Avoiding ADR is thus mandatory from both an ethical and an economic point of view. Whereas, pharmacogenetics changes of the pharmacokinetics may contribute to the explanation of some type A reactions, strong relationships of genetic markers has also been shown for drug hypersensitivity belonging to type B reactions. We present the classifications of ADR, discuss genetic influences and focus on delayed-onset hypersensitivity reactions, i.e., drug-induced liver injury, drug-induced agranulocytosis, and severe cutaneous ADR. A guidance how to read and interpret the contingency table is provided as well as an algorithm whether and how a test for a pharmacogenetic biomarker should be conducted.
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Affiliation(s)
- Ruwen Böhm
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein Kiel, Germany
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein Kiel, Germany
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Pham DL, Kim JH, Trinh THK, Park HS. What we know about nonsteroidal anti-inflammatory drug hypersensitivity. Korean J Intern Med 2016; 31:417-32. [PMID: 27030979 PMCID: PMC4855107 DOI: 10.3904/kjim.2016.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 03/05/2016] [Indexed: 02/07/2023] Open
Abstract
Nonsteroidal anti-inf lammatory drugs (NSAIDs) are widely prescribed for the treatment of inflammatory diseases, but their use is frequently related to hypersensitivity reactions. This review outlines our current knowledge of NSAID hypersensitivity (NHS) with regard to its pathogenic, molecular, and genetic mechanisms, as well as diagnosis and treatment. The presentation of NHS varies from a local (skin and/or airways) reaction to systemic reactions, including anaphylaxis. At the molecular level, NHS reactions can be classified as cross-reactive (mediated by cyclooxygenase inhibition) or selective (specific activation of immunoglobulin E antibodies or T cells). Genetic polymorphisms and epigenetic factors have been shown to be closely associated with NHS, and may be useful as predictive markers. To diagnose NHS, inhalation or oral challenge tests are applied, with the exclusion of any cross-reactive NSAIDs. For patients diagnosed with NHS, absolute avoidance of NSAIDs/aspirin is essential, and pharmacological treatment, including biologics, is often used to control their respiratory and cutaneous symptoms. Finally, desensitization is recommended only for selected patients with NHS. However, further research is required to develop new diagnostic methods and more effective treatments against NHS.
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Affiliation(s)
- Duy Le Pham
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, Korea
| | - Ji-Hye Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Tu Hoang Kim Trinh
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, Korea
- Correspondence to Hae-Sim Park, M.D. Department of Allergy and Clinical Immunology, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5150 Fax: +82-31-219-5154 E-mail:
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Drug hypersensitivity reactions: more basic and clinical research is needed. Curr Opin Allergy Clin Immunol 2015; 15:273-6. [PMID: 26110675 DOI: 10.1097/aci.0000000000000182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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