Safety, outcomes, and recommendations for two-step outpatient nonsteroidal anti-inflammatory drug challenges

Drug challenge protocols for evaluation of non-AERD related NSAID hypersensitivity can vary widely by provider and institution and can be prohibitively time and resource intensive to perform. In this cohort of 249 individuals undergoing NSAID drug challenges, we describe the safety and outcomes of a 2-step NSAID drug challenge protocol. Over 85% of challenges were negative for an immediate or delayed reaction, allowing patients to use at least one clinically indicated NSAID. Challenge reactions were generally mild. These results indicate that a simple 2-step NSAID challenge protocol may be safely used in the outpatient setting to delabel appropriate candidates.