Skip to main content

Advertisement

SpringerLink
Log in

Recent Updates in Understanding NSAID Hypersensitivity

  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To provide a review of available literature regarding nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity with an emphasis on more recent findings.

Recent Findings

Oral provocation tests with aspirin are important for diagnosis and management in adult and pediatric populations with reported NSAID hypersensitivity. Risk of cross-reactivity to COX-2 inhibitors varies by NSAID hypersensitivity phenotype. COX-2 inhibitors are tolerated in aspirin-exacerbated respiratory disease. Reported NSAID allergy is associated with a higher risk of a substance use disorder. Effective treatment of underlying chronic spontaneous urticaria can allow tolerance of NSAIDs in NSAID-exacerbated cutaneous disease.

Summary

The pathophysiology, cross-reactivity, and appropriate diagnostic evaluation differ between the 5 distinct NSAID hypersensitivity phenotypes. Further research into the pathophysiology of NSAID hypersensitivity in patients with and without underlying disease is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Chou R, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57. https://doi.org/10.1016/j.jpain.2015.12.008. Erratum in: J Pain. 2016;17(4):508-10. Dosage error in article text. (PMID: 26827847).

    Article  PubMed  Google Scholar 

  2. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Dec 23;64(24):e139-e228. https://doi.org/10.1016/j.jacc.2014.09.017. Epub 2014 Sep 23. Erratum in: J Am Coll Cardiol. 2014 Dec 23;64(24):2713–4. Dosage error in article text. PMID: 25260718.

  3. Sousa-Pinto B, Fonseca JA, Gomes ER. Frequency of self-reported drug allergy: a systematic review and meta-analysis with meta-regression. Ann Allergy Asthma Immunol. 2017;119:362-373.e2.

    Article  PubMed  Google Scholar 

  4. Zhou L, Dhopeshwarkar N, Blumenthal KG, Goss F, Topaz M, Slight SP, et al. Drug allergies documented in electronic health records of a large healthcare system. Allergy. 2016;71:1305–13.

    Article  CAS  PubMed  Google Scholar 

  5. Blumenthal KG, Lai KH, Huang M, Wallace ZS, Wickner PG, Zhou L. Adverse and hypersensitivity reactions to prescription nonsteroidal anti-inflammatory agents in a large health care system. J Allergy Clin Immunol Pract. 2017 May-Jun;5(3):737–743.e3.  https://doi.org/10.1016/j.jaip.2016.12.006. Epub 2017 Jan 18. PMID: 28110055; PMCID: PMC5423842.

  6. • Mori F, Atanaskovic-Markovic M, Blanca-Lopez N, Gomes E, Gaeta F, Sarti L, Bergmann MM, Tmusic V, Valluzzi RL, Caubet JC. A multicenter retrospective study on hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) in children: a report from the European Network on Drug Allergy (ENDA) Group. J Allergy Clin Immunol Pract. 2020;8(3):1022-1031.e1. https://doi.org/10.1016/j.jaip.2019.10.049. (Epub 2019 Nov 27 PMID: 31785410). Retrospective data collection of 693 children with a reported history of NSAID reaction. The diagnosis of NSAID hypersensitivity was confirmed in 19.3% of the 693 children by performing OPT to culprit drug. This study highlights the importance of oral provocation tests in confirming or excluding NSAID hypersensitivity in the pediatric population.

    Article  PubMed  Google Scholar 

  7. Laidlaw TM, Cahill KN. Current knowledge and management of hypersensitivity to aspirin and NSAIDs. J Allergy Clin Immunol Pract. 2017;5(3):537–545. https://doi.org/10.1016/j.jaip.2016.10.021. PMID: 28483309.

  8. Blumenthal KG, Acker WW, Li Y, Holtzman NS, Zhou L. Allergy entry and deletion in the electronic health record. Ann Allergy Asthma Immunol. 2017;118(3):380–381. https://doi.org/10.1016/j.anai.2016.12.020. Epub 2017 Jan 23. PMID: 28126435; PMCID: PMC5346466.

  9. • Li L, Chang Y, Song S, Losina E, Costenbader KH, Laidlaw TM. Impact of reported NSAID “allergies” on opioid use disorder in back pain. J Allergy Clin Immunol. 2021;147(4):1413–9. https://doi.org/10.1016/j.jaci.2020.08.025. (Epub 2020 Sep 9 PMID: 32916184). This is a retrospective cohort study using the electronic medical record to identify patients with back pain who reported NSAID allergy. This comprised of 3620 patients or 7.7% of patients with back pain. These patients had higher odds of both documented opiate prescription and developing an opiate use disorder than the patients with an NSAID allergy label. The results emphasize the importance of allergy evaluation for potential delabeling in patients reporting NSAID allergies.

    Article  CAS  PubMed  Google Scholar 

  10. Doña I, Pérez-Sánchez N, Eguiluz-Gracia I, Muñoz-Cano R, Bartra J, Torres MJ, Cornejo-García JA. Progress in understanding hypersensitivity reactions to nonsteroidal anti-inflammatory drugs. Allergy. 2020;75(3):561–75. https://doi.org/10.1111/all.14032. (Epub 2019 Oct 28 PMID: 31469167).

    Article  PubMed  Google Scholar 

  11. Kowalski ML, Makowska JS, Blanca M, et al. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA(#) and GA2LEN/HANNA*. Allergy. 2011;66(7):818–29. https://doi.org/10.1111/j.1398-9995.2011.02557.x. (Epub 2011 Feb 14 PMID: 21631520).

    Article  CAS  PubMed  Google Scholar 

  12. Kowalski ML, Asero R, Bavbek S, Blanca M, Blanca-Lopez N, Bochenek G, Brockow K, Campo P, Celik G, Cernadas J, Cortellini G, Gomes E, Niżankowska-Mogilnicka E, Romano A, Szczeklik A, Testi S, Torres MJ, Wöhrl S, Makowska J. Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy. 2013;68(10):1219–32. https://doi.org/10.1111/all.12260. (Epub 2013 Oct 5 PMID: 24117484).

    Article  CAS  PubMed  Google Scholar 

  13. • Kidon M, Blanca-Lopez N, Gomes E, Terreehorst I, Tanno L, Ponvert C, Chin CW, Caubet JC, Soyer O, Mori F, Blanca M, Atanaskovic-Markovic M. EAACI/ENDA Position Paper: diagnosis and management of hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) in children and adolescents. Pediatr Allergy Immunol. 2018;29(5):469–80. https://doi.org/10.1111/pai.12915. (Epub 2018 Jun 13 PMID: 29693290). A European consensus statement summarizing diagnosis and management recommendations for pediatric and adolescent patients with NSAID hypersensitivity. For this particular patient population, data is growing, but rare.

    Article  PubMed  Google Scholar 

  14. Lee Y, Shin YS, Park HS. New phenotypes in hypersensitivity reactions to nonsteroidal anti-inflammatory drugs. Curr Opin Allergy Clin Immunol. 2019;19(4):302–7. https://doi.org/10.1097/ACI.0000000000000541. (PMID: 31107257).

    Article  CAS  PubMed  Google Scholar 

  15. 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;8(12):217–33. https://doi.org/10.2147/JAA.S164806. (PMID: 31496752; PMCID: PMC6690438).

    Article  Google Scholar 

  16. Cahill KN, Bensko JC, Boyce JA, Laidlaw TM. Prostaglandin D2: a dominant mediator of aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2015;135(1):245–52. https://doi.org/10.1016/j.jaci.2014.07.031.

    Article  CAS  PubMed  Google Scholar 

  17. • Li L, Bensko J, Buchheit K, Saff RR, Laidlaw TM. Safety, outcomes, and recommendations for two-step outpatient nonsteroidal anti-inflammatory drug challenges. Allergy Clin Immunol Pract. 2022;10(5):1286-1292.e2. https://doi.org/10.1016/j.jaip.2021.11.006. (Epub 2021 Nov). A retrospective study of non-AERD patients reporting NSAID allergy in which 249 patients who underwent 262 NSAID challenges. Approximately 86% of two-step drug challenges were negative for immediate or delayed reactions allowing patients to use at least one clinically indicated NSAID. Also, challenge reactions that did occur were clinically mild. This study suggests that two-step NSAID challenges were able to delabel the majority of patients and that most positive tests had reactions which were safe to manage in an outpatient setting.

    Article  CAS  Google Scholar 

  18. O. Yilmaz Topal, I. Kulhas Celik, I. Turgay, Yagmur, M. Toyran, E. Civelek, B. Karaatmaca, et al. Results of NSAID provocation tests and difficulties in the classification of children with nonsteroidal anti-inflammatory drug hypersensitivity. Ann Allergy Asthma Immunol. 2020;125:202–207.

  19. Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, et al. The EAACI/GA2LEN/EDF/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018;73(7):1393–414. https://doi.org/10.1111/all.13397. (PMID: 29336054).

    Article  CAS  PubMed  Google Scholar 

  20. J. Sánchez Jorge, A. Sánchez, R. Cardona. Prevalence of drugs as triggers of exacerbations in chronic urticaria. J Investig Allergol Clin Immunol. 2019;29:112–117.

  21. Sánchez-Borges M, Caballero-Fonseca F, Capriles-Hulett A, González-Aveledo L. Aspirin-exacerbated cutaneous disease (AECD) is a distinct subphenotype of chronic spontaneous urticaria. J Eur Acad Dermatol Venereol. 2015;29:698–701.

    Article  PubMed  Google Scholar 

  22. Doña I, Blanca-López N, Cornejo-García JA, et al. Characteristics of subjects experiencing hypersensitivity to non-steroidal anti-inflammatory drugs: patterns of response. Clin Exp Allergy. 2011;41(1):86–95. https://doi.org/10.1111/j.1365-2222.2010.03651.x. (PMID: 21155908).

    Article  CAS  PubMed  Google Scholar 

  23. Fadhel NB, Chaabane A, Ammar H, et al. Clinical features, culprit drugs, and allergology workup in 41 cases of fixed drug eruption. Contact Dermatitis. 2019;81(5):336–40.

    Article  PubMed  Google Scholar 

  24. Belz D, Persa OD, Haese S, Hunzelmann N. Acute generalized exanthematous pustulosis caused by ibuprofen-diagnosis confirmed by patch testing. Contact Dermatitis. 2018;79(1):40–1. https://doi.org/10.1111/cod.12978. (Epub 2018 Mar 24 PMID: 29572854).

    Article  PubMed  Google Scholar 

  25. Woessner KM, Castells M. NSAID single-drug-induced reactions. Immunol Allergy Clin North Am. 2013;33(2):237–49. https://doi.org/10.1016/j.iac.2012.12.002. (Epub 2013 Feb 1PMID: 23639711).

    Article  PubMed  Google Scholar 

  26. Sylvestre S, Durf V, Al-Shaikhly T. M014 NSAID associated exercise-induced anaphylaxis. Ann Allergy Asthma Immunol. 2021;127(5):S62.

    Article  Google Scholar 

  27. Muñoz-Cano R, San Bartolome C, Casas-Saucedo R, Araujo G, Gelis S, Ruano-Zaragoza M, Roca-Ferrer J, Palomares F, Martin M, Bartra J, Pascal M. Immune-mediated mechanisms in cofactor-dependent food allergy and anaphylaxis: effect of cofactors in basophils and mast cells. Front Immunol. 2021;11:623071. https://doi.org/10.3389/fimmu.2020.623071. PMID: 33679712

  28. Boyce JA. Advances in mast cell biology. J Allergy Clin Immunol. 2022;S0091–6749(22):00487–0. https://doi.org/10.1016/j.jaci.2022.03.029. Epub ahead of print. PMID: 35427642.

  29. Kay LJ, Yeo WW, Peachell PT. Prostaglandin E2 activates EP2 receptors to inhibit human lung mast cell degranulation. Br J Pharmacol. 2006;147(7):707–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Sestini P, Armetti L, Gambaro G, Pieroni MG, Refini RM, Sala A, Vaghi A, Folco GC, Bianco S, Robuschi M. Inhaled PGE2 prevents aspirin-induced bronchoconstriction and urinary LTE4 excretion in aspirin-sensitive asthma. Am J Respir Crit Care Med. 1996;153(2):572–5.

    Article  CAS  PubMed  Google Scholar 

  31. Maric J, Ravindran A, Mazzurana L, Björklund ÅK, Van Acker A, Rao A, Friberg D, Dahlén SE, Heinemann A, Konya V, Mjösberg J. Prostaglandin E2 suppresses human group 2 innate lymphoid cell function. J Allergy Clin Immunol. 2018;141(5):1761-1773.e6. https://doi.org/10.1016/j.jaci.2017.09.050. (Epub 2017 Dec 5).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Himly M, Jahn-Schmid B, Pittertschatscher K, Bohle B, Grubmayr K, Ferreira F, Ebner H, Ebner C. IgE-mediated immediate-type hypersensitivity to the pyrazolone drug propyphenazone. J Allergy Clin Immunol. 2003;111(4):882–8. https://doi.org/10.1067/mai.2003.163. (PMID: 12704373).

    Article  CAS  PubMed  Google Scholar 

  33. Doña I, Barrionuevo E, Salas M, Laguna JJ, Agúndez J, García-Martín E, Bogas G, Perkins JR, Cornejo-García JA, Torres MJ. NSAIDs-hypersensitivity often induces a blended reaction pattern involving multiple organs. Sci Rep. 2018;8(1):16710. https://doi.org/10.1038/s41598-018-34668-1. (PMID: 30420763; PMCID: PMC6232098)

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ortega N, Doña I, Moreno E, Audicana MT, Barasona MJ, Berges-Gimeno MP, et al. Practical guidelines for diagnosing hypersensitivity reactions to nonsteroidal anti-inflammatory drugs. J Investig Allergol Clin Immunol. 2014;24:308–23.

    CAS  PubMed  Google Scholar 

  35. Broyles AD, et al. Practical guidance for the evaluation and management of drug hypersensitivity: specific drugs. J Allergy Clin Immunol Pract. 2020;8(9S):S16–116. https://doi.org/10.1016/j.jaip.2020.08.006. Erratum in: J Allergy Clin Immunol Pract. 2021;9(1):603. Erratum in: J Allergy Clin Immunol Pract. 2021;9(1):605. (PMID: 33039007).

    Article  PubMed  Google Scholar 

  36. • Blanca-Lopez N, Haroun-Diaz E, Ruano FJ, Perez-Alzate D, Somoza ML, Vasquez de la Torre Gaspar, et al. Acetyl salicylic acid challenge in children with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs differentiates between cross-intolerant and selective responders. J Allergy Clin Immunol Pract. 2018;6:1226–1235. A study of 116 children (all less than 14 years old) with history of NSAID allergy who underwent a single blind oral provocation test with ASA (unless ASA was the culprit drug, then ibuprofen). If positive, cross-intolerance was confirmed. If negative, the patient was challenged with culprit drug. 26% were diagnosed with NSAID allergy. 83% of which were cross-intolerant and 17% had selective allergies. ASA challenge proved to be a safe and reasonable first step in diagnosis and management of NSAID allergy in pediatric patients.

  37. Eser Simsek I, Cogurlu MT, Aydogan M. Two approaches for diagnosis of nonsteroidal anti-inflammatory drug hypersensitivity in children. Ann Allergy Asthma Immunol. 2019;123(4):389–93. https://doi.org/10.1016/j.anai.2019.07.005. (Epub 2019 Jul 16 PMID: 31323315).

    Article  CAS  PubMed  Google Scholar 

  38. • Martínez Antón MD, Galán Gimeno C, Sánchez de Vicente J, Jáuregui Presa I, Gamboa Setién PM. Etoricoxib-induced fixed drug eruption: report of seven cases. Contact Dermatitis. 2021;84(3):192–195. https://doi.org/10.1111/cod.13659. Epub 2020 Aug 18. PMID: 32666601. A report of seven cases of fixed drug eruption (FDE) induced by etoricoxib (a selective COX-2 inhibitor) diagnosed on clinical presentation. In six of the cases, the diagnosis was confirmed with positive patch testing, and the other case had positive low-dose oral challenge. NSAIDs are suspected to be a common cause of FDE.

  39. • 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(9):1346–55. https://doi.org/10.1111/all.13147. (Epub 2017 Mar 20 PMID: 28226401). This study identified 38 patients with history of NIUA and positive oral challenge to ASA and prospectively re-evaluated them with both ASA and other NSAIDs after 60 months and then 78 months from initial evaluation. The majority of patients approximately 63% tolerated ASA and other NSAIDs at 60 months, and this number remained similar at 78 months. A shorter time interval to tolerance was noted in patients with isolated urticarial, non-atopic patients, and those who experienced reactions over 1 h after exposure. This study suggests that patients with NIUA may develop tolerance and repeat evaluation at least three 3 years out from initial reaction may be reasonably considered.

    Article  CAS  PubMed  Google Scholar 

  40. • Li L, Laidlaw T. Cross-reactivity and tolerability of celecoxib in adult patients with NSAID hypersensitivity. J Allergy Clin Immunol Pract. 2019;7(8):2891–2893.e4. https://doi.org/10.1016/j.jaip.2019.04.042. Epub 2019 May 14. PMID: 31100553. Meta-analysis of blinded, placebo-controlled trials prior to November of 2018 in which patients with NSAID allergies were challenged with selective COX-2 inhibitors. Sixty-two62 studies were identified. Celecoxib and rofecoxib were the most commonly used. A reaction rate of 3.29% was calculated with the majority of reactions being isolated cutaneous reactions. Although selective COX-2 inhibitors are generally well tolerated in patients with NSAID hypersensitivity, a history of urticarial and/or angioedema or anaphylaxis due to small risk of cross-reactivity OPT was recommended prior to use. AERD patients may use selective COX-2 inhibitors without prior challenge.

  41. • Sánchez J, Diez S, Cardona R. Clinical control of CSU with antihistamines allows for tolerance of NSAID-exacerbated cutaneous disease. J Allergy Clin Immunol Pract. 2020;8(10):3577–3583.e1. https://doi.org/10.1016/j.jaip.2020.06.057. Epub 2020 Jul 14. PMID: 32673879. A total of 121 patients with CSU and a history of NSAID-induced exacerbation were evaluated with two challenges—without the use of anti-histamines and with pre-treatment using anti-histamines. Ninety-sixsix patients tested positive without anti-histamine pretreatment; however, 72 of these patients had a negative challenge with anti-histamine pretreatment. These results indicate that clinical control of underlying CSU with anti-histamines may allow for unnecessary avoidance of NSAIDS by decreasing NSAID-induced exacerbations of disease.

  42. • Rossini R, Iorio A, Pozzi R, Bianco M, Musumeci G, Leonardi S, Lettieri C, Bossi I, Colombo P, Rigattieri S, Dossena C, Anzuini A, Capodanno D, Senni M, Angiolillo DJ. Aspirin desensitization in patients with coronary artery disease: results of the multicenter ADAPTED Registry (Aspirin Desensitization in Patients With Coronary Artery Disease). Circ Cardiovasc Interv. 2017;10(2):e004368. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004368. PMID: 28193678. A prospective, multicenter study of 330 patients with both a history of ASA hypersensitivity and coronary artery disease underwent rapid ASA desensitization and was successful in 315 of the patients. The 15 patients without successful desensitization had minor reactions that responded to treatment with steroids and antihistamines. A total of 253 of the patients continued aspirin for 12 months. The other 62 stopped aspirin due to medical recommendation, not because of a hypersensitivity reaction. A rapid desensitization protocol was with both effective and safe in a variety of patients regardless of initial aspirin reaction which allows for appropriate treatment of coronary artery disease.

  43. Chopra AM, Díez-Villanueva P, Córdoba-Soriano JG, Lee JKT, Al-Ahmad M, Ferraris VA, Mehta M, Kowalski ML. Meta-analysis of acetylsalicylic acid desensitization in patients with acute coronary syndrome. Am J Cardiol. 2019;124(1):14–9. https://doi.org/10.1016/j.amjcard.2019.03.047. (Epub 2019 Apr 10 PMID: 31027657).

    Article  CAS  PubMed  Google Scholar 

  44. Staicu ML, Vyles D, Shenoy ES, Stone CA, Banks T, Alvarez KS, Blumenthal KG. Penicillin allergy delabeling: a multidisciplinary opportunity. J Allergy Clin Immunol Pract. 2020;8(9):2858-2868.e16.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Espersen J, Weber U, Römer-Franz A, Lenarz T, Stolle SRO, Warnecke A. Level of sex hormones and their association with acetylsalicylic acid intolerance and nasal polyposis. PLoS ONE. 2020;15(12): e0243732.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Blanca-Lopez N, Perez-Alzate D, Cornejo JA, Haroun E, Blanca M, Canto G. Hypersensitivity reactions to NSAIDs in children. J Allergy Clin Immunol Pract. 2017;1:139(2): AB34

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA

    Ellen Minaldi

  2. Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, USA

    Katherine Cahill

Authors
  1. Ellen Minaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine Cahill
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine Cahill.

Ethics declarations

Conflict of Interest

Ellen Minaldi declares no conflict of interest. Katherine Cahill reports personal fees from MyCME and personal fees from Elsevier Clinical Key, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Minaldi, E., Cahill, K. Recent Updates in Understanding NSAID Hypersensitivity. Curr Allergy Asthma Rep 23, 181–188 (2023). https://doi.org/10.1007/s11882-023-01064-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11882-023-01064-3

Keywords

Search

Navigation