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Background: In up to 70%–80% of patients with a suspected non‐steroidal anti‐inflammatory drug hypersensitivity (NSAIDH), challenge tests with the culprit drug yield negative results. On the other hand, there could be a NSAIDH overdiagnosis when anaphylaxis is the clinical manifestation. We hypothesize that some negative NSAID challenge tests and an overdiagnosis of NSAIDH occur in patients with food‐dependent NSAID‐induced hypersensitivity (FDNIH). Methods: We studied 328 patients with a suspected acute NSAIDH. FDNIH was diagnosed in patients meeting all the following: (1) tolerance to the food ingested more temporally closed before the reaction, later the episode, (2) respiratory or cutaneous symptoms or anaphylaxis related to NSAID, (3) positive skin prick test to foods and/or specific IgE to food allergens (Pru p 3, Tri a 19, Pen a 1) involved in the reaction, and (4) negative oral provocation test to the culprit NSAID. Results: 199 patients (60%) were diagnosed with NSAIDH and 52 (16%) with FDNIH. Pru p 3 was involved in 44 cases (84.6%) and Tri a 19 in 6 cases (11%). FDNIH subjects were younger (p <.001), with a higher prevalence of rhinitis (p <.001) and previous food allergy (p <.001), together with a higher proportion of subjects sensitized to pollens (p <.001) and foods (p <.001). Using just four variables (Pru p 3 sensitization, Tri a 19 sensitization, anaphylaxis, and any NSAID different from pyrazolones), 95.3% of cases were correctly classified, with a sensitivity of 92% and specificity of 96%. Conclusion: Evaluation of FDNIH should be included in the diagnostic workup of NSAIDH. [ABSTRACT FROM AUTHOR]

Background: Most patients with nonallergic asthma have normal serum immunoglobulin E (IgE) levels. Recent reports suggest that total and aeroallergen-specific IgE levels in induced sputum may be higher in nonallergic asthmatics than in healthy controls. Our objective is to compare total and dust-mite specific (Der p 1) IgE levels in induced sputum in allergic and nonallergic asthmatics and healthy controls., Methods: Total and Der p 1-specific IgE were measured in induced sputum (ImmunoCAP immunoassay) from 56 age- and sex-matched asthmatics (21 allergic, 35 nonallergic) and 9 healthy controls. Allergic asthma was defined as asthma with a positive prick test and/or clinically-significant Der p 1-specific serum IgE levels., Results: Patients with allergic asthma presented significantly higher total and Der p 1-specific serum IgE levels. There were no significant between-group differences in total sputum IgE. However, Der p 1-specific sputum IgE levels were significantly higher (p = 0.000) in the allergic asthmatics, but without differences between the controls and nonallergic asthmatics. Serum and sputum IgE levels were significantly correlated, both for total IgE (rho = 0.498; p = 0.000) and Der p 1-specific IgE (rho, 0.621; p = 0001)., Conclusions: Total IgE levels measured in serum and induced sputum are significantly correlated. No significant differences were found between the differents groups in total sputum IgE. Nevertheless, the levels of Der p 1-specific sputum IgE levels were significantly higher in the allergic asthmatics, but without differences between the controls and nonallergic asthmatics. Probably due to the lack of sensitivity of the test used, but with the growing evidence for local allergic reactions better methods are need to explore its presence. The Clinical Trials Identifier for this project is NCT03640936., Competing Interests: AC. in the last three years received honoraria for speaking at sponsored meetings from AstraZeneca, Chiesi, Esteve Laboratories, Faes Farma, Ferrer, GlaxoSmithKline, Novartis, Teva, Zambon. Received help assistance to meeting travel from Bial, Novartis. Act as a consultant for AstraZeneca, Boehringer, GlaxoSmithKline, Novartis. And received funding/grant support for research projects from a variety of Government agencies and not-for-profit foundations, as well as AstraZeneca. EC has received funding to travel to and attend training activities from ALK, Menarini, Teva, AstraZeneca, Chiesi, Boehringer, and Novartis. LS, EM and declare no conflict of interests. JG has received funding to travel and attend to training activities from Menarini, Teva, AstraZeneca, Chiesi, GSK, Mundipharma, Boehringer. In the last three years, VP has received honoraria for speaking at sponsored meetings from AstraZeneca, Boehringer-Ingelheim, Chiesi, GSK, and Novartis. VP has also received financial support to travel to meetings organized by Chiesi and Novartis. VP is a consultant for ALK, AstraZeneca, Boehringer, MundiPharma, and Sanofi. VP has also received funding/grant support for research projects from a variety of governmental agencies and not-for-profit foundations, as well as from AstraZeneca, Chiesi and Menarini.