From the Guidelines
Individuals with aspirin hypersensitivity do not necessarily have a high frequency of adverse reactions to ibuprofen, as the underlying etiology of these reactions is not fully understood and may not be due to cross-reactivity. According to the most recent study 1, the clinical pattern of a preceding period of sensitization during which the drug is tolerated suggests an IgE-mediated mechanism, but there are limited reports of detection of specific IgE to NSAIDs.
Key Points to Consider
- The study 1 highlights that any NSAID, including selective COX-2 inhibitors, may be responsible for the reaction, and it is not due to arachidonic acid dysfunction.
- The evidence 1 suggests that when there is a history of multiple reactions to structurally dissimilar NSAIDS (eg, ibuprofen and aspirin), the rate of a positive challenge increases.
- However, the study 1 notes that cross-reactivities within the same chemical class are not universal, and for severe reactions, avoidance without rechallenge within that class is recommended.
Management and Recommendations
- It is essential to determine the culprit NSAID and consider alternative options for pain control. If a patient has a known aspirin allergy, it is crucial to consult with a healthcare provider before taking any medication, including ibuprofen.
- Acetaminophen (Tylenol) is usually a safe alternative for pain relief as it works through a different mechanism.
- Consideration should be made for the chemical structure of the culprit NSAID, and an alternative class might be tolerated in this situation, although studies in these situations are lacking 1.
From the Research
Frequency of Adverse Reactions to Ibuprofen in Individuals with Aspirin Hypersensitivity
- The frequency of adverse reactions to ibuprofen in individuals with aspirin hypersensitivity is not explicitly stated in the provided studies, but it can be inferred that there is a potential for cross-reactivity between aspirin and other NSAIDs, including ibuprofen 2, 3, 4.
- A study published in 2006 found that patients with aspirin hypersensitivity may develop cross-reactions to other NSAIDs, including ibuprofen, although the exact frequency of such reactions is not specified 2.
- Another study published in 2007 reported that 50% of children with allergic-like reactions to antipyretics, antalgics, and NSAIDs were diagnosed with intolerance to these drugs, and that the risk was higher in children reporting reactions to NSAIDs such as aspirin and ibuprofen 3.
- A study published in 2019 characterized the demographics and clinical course of hypersensitivity reactions in a cohort of patients with ibuprofen allergy, but did not specifically address the frequency of adverse reactions to ibuprofen in individuals with aspirin hypersensitivity 5.
Cross-Reactivity between Aspirin and Ibuprofen
- Cross-reactivity between aspirin and other NSAIDs, including ibuprofen, is a well-documented phenomenon 2, 3, 4.
- A study published in 2006 found that patients with aspirin hypersensitivity may develop cross-reactions to other NSAIDs, including ibuprofen, due to their strong inhibitory activity towards cyclo-oxygenase (COX)-1 2.
- Another study published in 2007 reported that cross-reactivity between NSAIDs, including aspirin and ibuprofen, is common, and that patients with hypersensitivity to one NSAID may be at risk of reacting to other NSAIDs 3.
Clinical Manifestations of Ibuprofen Hypersensitivity
- The clinical manifestations of ibuprofen hypersensitivity can range from mild to severe, and may include cutaneous manifestations such as urticaria and angioedema, as well as respiratory and gastrointestinal symptoms 5.
- A study published in 2019 found that urticaria and angioedema were seen in 90% of patients with ibuprofen hypersensitivity, and that the reactions were typically mild or moderate in severity, although severe anaphylaxis can occur 5.