ORIGINAL RESEARCH article
Front. Allergy
Sec. Drug, Venom & Anaphylaxis
Volume 6 - 2025 | doi: 10.3389/falgy.2025.1611309
Labeled NSAID Hypersensitivity and the Risk of Opioid Prescribing; An Observational Study
Provisionally accepted
- 1Ministry of National Guard Health Affairs (Saudi Arabia), Riyadh, Saudi Arabia
- 2King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- 3King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- 4King Abdulaziz Medical City, Riyadh, Saudi Arabia
- 5Western University, London, Ontario, Canada
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: NSAIDs are widely used for pain management but are second only to antibiotics in causing drug hypersensitivity reactions. Misclassification of these reactions often leads to unnecessary avoidance of the entire drug class, potentially resulting in increased opioid prescribing. This study aimed to assess the prevalence and characteristics of NSAID hypersensitivity, cross-reactivity patterns, and the association between NSAID hypersensitivity and opioid prescribing. The use of COX-2 selective inhibitors as a safe alternative was also explored.Methods: A retrospective cohort study was conducted at a tertiary care hospital, including patients with documented NSAID hypersensitivity between 2016 and 2023. Data on demographics, hypersensitivity reactions, NSAID cross-reactivity, and opioid prescriptions were collected. Patients with penicillin hypersensitivity were included for comparison. Logistic regression was used to analyze the association between NSAID hypersensitivity and opioid prescribing.Results: Among 319 patients with NSAID hypersensitivity, 30% (n=96) were classified as true allergy, 12.5% (n=40) as pseudo-allergy, and 57% (n=183) were unclassified. Cross-reactivity between NSAIDs was observed in 13%, although 52% tolerated at least one other NSAID.Patients with NSAID hypersensitivity were 62% more likely to be prescribed opioids compared to those with penicillin hypersensitivity (adjusted OR 1.62 [95% CI: 1.40-1.88], p < 0.001).Celecoxib was underutilized, prescribed to only 10% of hypersensitive patients. Conclusion: NSAID hypersensitivity is associated with increased opioid prescribing due to classwide avoidance. Despite concerns about cross-reactivity, many patients can tolerate alternative NSAIDs. Improved classification tools and clinical decision support systems are needed to guide prescribers.
Keywords: Cross-allergy, Hypersensitivity, Nonsteroidal anti-inflammatory drug (NSAID), Opioid use, Pseudo-allergy. Labeled NSAID Hypersensitivity and the Risk of Opioid Prescribing; An Observational Study
Received: 14 Apr 2025; Accepted: 17 Jul 2025.
Copyright: © 2025 Abu Esba, Alhoraibi, Abu Al-Burak and Ardah. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Laila Carolina Abu Esba, Ministry of National Guard Health Affairs (Saudi Arabia), Riyadh, 11426, Saudi Arabia
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.