Clinical implication of the serum periostin level for differentiating phenotypes of NSAID hypersensitivity

[Dear Editor, ] Nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity is a common drug allergy, in which 2 major phenotypes, respiratory (aspirin-exacerbated respiratory disease [AERD]) and cutaneous (aspirin-exacerbated cutaneous disease [AECD] or aspirin-intolerant acute urticaria [AIAU]) types, are noted. Typical symptoms of the respiratory type of NSAID hypersensitivity are dyspnea, cough, and rhinorrhea, while those of the cutaneous type are urticaria and angioedema. However, it is sometimes confused to establish in patients with chest tightness or dyspnea after ingestion of NSAIDs because the symptoms may originated from bronchoconstriction of AERD or from angioedema of AIAU. Periostin is an extracellular matrix protein and structurally homologous with fasciclin I, an insect adhesion molecule. The serum periostin level correlates well with eosinophilic airway inflammation and considered a prognostic factor for the treatment of lebrikizumab (a monoclonal antibody to IL-13).