Hypersensitivity to dipyrone in aspirin-exacerbated respiratory disease patients is associated with urticaria

Respir Med. 2020 Aug-Sep:170:106041. doi: 10.1016/j.rmed.2020.106041. Epub 2020 May 26.


Objective: To phenotype patients with aspirin-exacerbated respiratory disease (AERD) according to the presence of atopy, urticaria and level of peripheral eosinophils.

Methods: This study included adult asthmatic patients with AERD followed up at a tertiary hospital. They were classified according to atopy and/or urticaria, assessing clinical and laboratorial differences among the groups in order to identify possible aggravating factors of the disease.

Results: We included 73 patients, 78.1% being female with a mean age of 54.0 years. Severe asthma was observed in 68.5% and respiratory exacerbation with dipyrone in 67.1% of these patients. They had median total serum IgE of 191.6 IU/mL, mean peripheral eosinophils of 718.5 cells/mm3, and 50.7% were atopic. Urticaria was observed in 32.9% of them, and exacerbations were more often triggered by dipyrone (p = .016). Atopic patients were younger than nonatopic patients (p = .023), and had, on average, higher total serum IgE levels (p = .022). We observed a good correlation between asthma severity and peripheral eosinophils count (r2 = 026; p = .021).

Conclusions: In this study, severe asthma was highly prevalent in AERD patients. Likewise, urticaria was quite prevalent and its presence was associated with dipyrone induced hypersensitivity reaction. Atopy was found in half of the patients, with no association with asthma severity. Patients with higher levels of peripheral eosinophils had more severe asthma. Dypirone hypersensitivity may be a marker for concomitant respiratory and cutaneous hypersensitivity reactions.

Keywords: Aspirin-exacerbated respiratory disease (AERD); Atopy; Dipyrone; Eosinophils; Urticaria.

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Aspirin / adverse effects*
  • Asthma, Aspirin-Induced / etiology*
  • Asthma, Aspirin-Induced / immunology
  • Dipyrone / adverse effects*
  • Dipyrone / immunology*
  • Disease Progression
  • Drug Hypersensitivity / complications*
  • Drug Hypersensitivity / immunology
  • Eosinophils
  • Female
  • Humans
  • Hypersensitivity, Immediate / complications*
  • Hypersensitivity, Immediate / immunology
  • Leukocyte Count
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Urticaria / complications*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Dipyrone
  • Aspirin