What Is NSAID Allergy

  • Hadia Ashraf-Satwilkar Master of Research in Experimental Cancer Medicine – MRes, The University of Manchester, UK
  • Asma Hadjadj Master's degree, Pharmaceutical Sciences, Kingston University, UK

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What are NSAIDs?

NSAIDs, which stand for “non-steroidal anti-inflammatory drugs”, are a group of drugs used to reduce inflammation in the body, alleviate pain and lower a high temperature.¹ 

NSAIDs can be used for the following conditions:

  • Headaches
  • Fever
  • Menstrual pain
  • Strained of sprained ligaments
  • Chronic pain conditions such as arthritis
  • Respiratory viruses include colds, flu, and even coronavirus.¹

Examples of NSAIDs

NSAIDs come in a variety of formulations, including capsules, tablets, injections, creams, gels and suppositories (inserted via the bottom). Some NSAIDs require a prescription, while others can be bought over the counter directly from a pharmacy.¹

Below are a few examples of NSAIDs:

  • Naproxen
  • Ibuprofen
  • Aspirin (low-dose aspirin is not classed as an NSAID).
  • Celecoxib
  • Diclofenac
  • Etoricoxib
  • Mefenamic acid
  • Pain-relief dose aspirin.¹

What is an allergy? 

An allergy is the immune system’s response to a particular item (known as an allergen). In the majority of people, this item can be harmless; however, for those who have an allergy, this item may impact their health. In such individuals, the immune system detects the item to be a threat and so creates an immune response. The severity of this can vary from a simple itch to a life-threatening reaction.² 

Allergies to various items are common across the population. They are more common in children due to their lesser-developed immune systems. Often, allergies during childhood disappear with age, whilst some can remain lifelong.² 

Why does an allergic reaction happen

An immune reaction occurs when a person comes into contact with an allergen. When the allergen is in the body, it triggers an antibody response. When the allergen and antibody meet, a compound is released called histamine. Histamine is responsible for symptoms such as inflammation, tissue swelling and itching. When coming into contact with an allergen, an allergic reaction can occur within minutes.² 

Symptoms of an allergic reaction

The following is a list of symptoms typically encountered during an allergic reaction:

  • Sneezing or a runny nose
  • Nasal or ear congestion
  • Difficulty breathing
  • Shortness of breath
  • Wheezing
  • Coughing
  • Swelling of the lips face or any other part of the body.
  • Itching of the eyes, lips, ears, mouth or throat
  • Redness of the eyes, lips, ears, mouth or throat
  • Sinus pain
  • Hives or a nettle rash
  • Abdominal pain
  • Diarrhea
  • Nausea
  • Vomiting
  • Tenderness or pain around eyes, forehead or cheeks.¹

Anaphylaxis

Anaphylaxis is a very severe form of an allergic reaction. It is a medical emergency as it can be life-threatening and can cause a person to go into shock. Signs of an anaphylactic reaction are:

  • Unconsciousness
  • Sudden low blood pressure
  • Extreme difficulty breathing
  • Feeling light-headed
  • A weak and rapid pulse
  • Rash
  • Nausea and vomiting.³

In the event of anaphylaxis (severe allergic reaction), call 999 and seek urgent medical attention. If you have been prescribed an epinephrine/adrenaline auto-injection (EpiPen, etc.), administer a dose immediately. In the event of symptoms improving after administering a dose, it is important to seek urgent medical attention as this can wear off, and the symptoms may return.³

What is an NSAID allergy?

NSAIDs are extremely effective medications in treating pain and inflammation; however, similar to all medications, they may have undesired effects (known as side effects), as well as cause an allergy.

Symptoms of an NSAID allergy

  • Skin itching
  • Hives
  • Red eyes
  • Runny nose
  • Swollen tongue, face or lips
  • Shortness of breath
  • Coughing or wheezing

If you experience any of these symptoms after taking an NSAID and find it troubling, stop taking it immediately and let your doctor/medical professional know.² 

Anaphylaxis can also occur when taking an NSAID, and it is important to seek urgent medical attention in this case.²  

Risk factors of an NSAID allergy

People are more likely to experience an allergy to NSAIDs if:

  • They are related to someone who has an allergy to NSAIDs
  • They are a child
  • Have asthma, hay fever, eczema or any other allergic conditions.³

Complications of an NSAID allergy

Having an NSAID allergy can increase your chances of developing other health conditions, as well as worsen current health issues such as:

  • Anaphylaxis: experiencing a severe allergic reaction to an NSAID could mean you are more likely to experience an anaphylactic reaction further down the line
  • Asthma: The majority of patients who have an allergy also suffer from asthma. 
  • Sinusitis, lung and ear infections: immune responses can increase the likelihood of experiencing these.³

Diagnosing an NSAID allergy

If you suspect an NSAID allergy, see your doctor or medical professional in the first instance. 

The doctor or medical professional may ask a series of questions, conduct tests, or even refer to a specialist to accurately confirm an NSAID allergy. It can sometimes be difficult to diagnose an allergy as symptoms can be similar to another condition.² 

If you suspect an NSAID allergy, it may be useful to keep a record of the following information. Your doctor or medical professional may also ask the following:

  • How soon after taking an NSAID do you experience symptoms?
  • How long do symptoms last?
  • Do you experience symptoms every time you administer an NSAID?
  • Do symptoms occur at a certain time of the day?
  • Do symptoms occur during a particular time of the year?
  • Do symptoms occur when you are carrying out a particular activity?
  • Do symptoms occur in the house or outside the house?
  • Are you allergic to any foods or pets?
  • Do you experience symptoms when you are around certain animals or when you have eaten certain food?2,4

Skin prick testing

A skin prick test is a common and straightforward test for allergies. An NSAID in liquid form is gently injected into the arm. If there is an NSAID allergy, then an itch or red bump will appear in about 15 minutes. Skin prick testing is a safe and non-invasive procedure and does not involve any discomfort.2 

Blood tests

This can be used alongside a skin prick test to diagnose an NSAID allergy. A blood sample is taken and tested for antibodies to measure an immune response. The procedure is similar to a routine blood test, and the turnaround for results can be relatively quick.2 

Drug challenge test

This test is also an aid in confirming a drug allergy and takes place under strict medical supervision. Increasing doses of an NSAID are administered, and there is close monitoring of any signs and symptoms.5 

How to manage an NSAID allergy

To manage your allergy, it is useful to follow the below steps:

  • Make sure you document a description of each reaction, when it happened and how long it lasted.
  • Avoid NSAIDs altogether to reduce the risk of experiencing an allergic reaction.
  • Discuss with your doctor or healthcare provider whether there are any treatments that you can take to manage symptoms e.g. proton pump inhibitors for gastrointestinal symptoms or antihistamines for itching and rashes.²  
  • It is important to make sure that your doctor or medical professional has documented your allergy on your record. 
  • If you work with or come into contact with any healthcare provider or medical professional, it is important to inform them of your allergy.

Where possible, if you do have an NSAID allergy, it is best to avoid it completely to prevent a reaction.² 

NSAID alternatives

If you are using NSAIDs to manage pain, paracetamol is a suitable option to purchase over the counter. Stronger non-NSAID analgesics can also be prescribed by your doctor.

If you are experiencing an NSAID reaction affecting an internal body system and you are treating joint/muscle pain,  then an NSAID in a gel or cream formulation may help.1

Summary

NSAIDs are very effective medicines used to treat a variety of conditions. An allergy to an NSAID is not uncommon. If you experience symptoms when starting a new NSAID, speak to your doctor or health care professional immediately. If you experience anaphylaxis, seek medical attention immediately. 

References

  1. nhs.uk [Internet]. 2017 [cited 2023 Sep 6]. NSAIDs. Available from: https://www.nhs.uk/conditions/nsaids/
  2. Allergy UK | National Charity [Internet]. [cited 2023 Sep 11]. What is an Allergy? Available from: http://allergyuk.org
  3. Mayo Clinic [Internet]. [cited 2023 Sep 11]. Allergies - Symptoms and causes. Available from: https://www.mayoclinic.org/diseases-conditions/allergies/symptoms-causes/syc-20351497
  4. Contacting a Healthcare Professional If You Think You Have a Drug Allergy | Information for the Public | Drug Allergy: Diagnosis and Management | Guidance | NICE. 3 Sept. 2014, https://www.nice.org.uk/guidance/cg183/ifp/chapter/contacting-a-healthcare-professional-if-you-think-you-have-a-drug-allergy.
  5. Drug challenge testing | Royal Brompton & Harefield hospitals [Internet]. [cited 2023 Sep 11]. Available from: https://www.rbht.nhs.uk/our-services/drug-challenge-testing

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Hadia Ashraf-Satwilkar

Non-Medical Independent Prescribing - AdvDip, University of Bolton, UK
Master of Research in Experimental Cancer Medicine – MRes, The University of Manchester, UK
Clinical Pharmacy Practice - PGDip, Robert Gordon University, Scotland
Master of Pharmacy - MPharm, University of Bradford, UK


Hadia is a GPhC-registered pharmacist, with several years' experience in community, hospital, aseptic manufacturing, pharmaceutical industry and GP settings.
Here, she has undertaken both managerial as well as education and training roles.
She has a strong background and passion for clinical research, which she has now extended to medical writing.

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