Ibuprofen Allergy: Understanding Allergic Reactions to NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a staple of medicine cabinets. They’re some of the most effective and popular over-the-counter (OTC) pain relievers. And the reason is clear: They help relieve all types of pain, from arthritis to sore muscles and headaches. Plus, they’re a powerful fever reliever. 

But NSAIDs are medications, so it’s possible to have an allergic reaction to them. If you develop an ibuprofen allergy, you can still take some OTC pain relievers. 

Here’s how you can tell if you have an NSAID allergy and how to choose a safe alternative.

What are NSAIDs?

NSAIDs are medications that relieve symptoms of inflammation like pain and fever. They work by blocking COX enzymes, which trigger inflammation. 

Your body has two types of COX enzymes: COX-1 and COX-2. Older NSAIDs block both COX-1 and COX-2, while newer NSAIDS (selective COX-2 inhibitors) only block COX-2.

Older NSAIDs are available OTC and include:

• Aspirin

• Ibuprofen (Motrin, Advil)

• Naproxen (Aleve, Naprosyn)

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Selective and relative COX-2 inhibitors are available by prescription:

• Celecoxib (Celebrex)

• Meloxicam (Mobic)

Although it has some similar uses, acetaminophen (Tylenol) is not an NSAID.

What causes NSAID allergies?

There are two types of NSAID allergies. 

1. Immune-mediated reaction

The first type is caused by your immune system’s reaction to the medication. This is the kind of allergic reaction that comes to mind when most people think of a medication allergy. These NSAID allergies start all of a sudden and can cause life-threatening anaphylaxis.

2. Nonimmune-mediated reaction

The second type is more complicated and has nothing to do with your immune system. In short, sometimes the body doesn’t work exactly like it should, and it leads to an allergic reaction. 

Scientists aren’t sure why this happens to some people. But research shows that it’s more likely to happen to people with certain medical conditions like asthma or chronic hives. 

This type of reaction happens when people take any NSAIDs that block the COX-1 enzyme. Selective COX-2 inhibitors don’t cause these types of reactions.   

How do you know if you have an allergy to NSAIDs?

Both types of NSAID allergies cause similar symptoms, including: 

• Hives

• Wheezing

• Cough

• Face swelling

• Congestion

• Trouble breathing

• Itching

NSAID allergies are uncommon. Only about 2% of people develop one. 

But keep in mind that ibuprofen allergy is the most common type of NSAID allergy. So make sure to seek immediate medical care if you develop symptoms after taking ibuprofen. You can develop an ibuprofen allergy suddenly. So even if you’ve never had a reaction before, don’t take a wait-and-see approach if you have new symptoms. 

How long does it take to have an allergic reaction to ibuprofen?

Symptoms of any NSAID allergy, including ibuprofen allergy, start 30 to 60 minutes after taking NSAIDs. If you have any of these symptoms, go to the nearest emergency room. 

Since symptoms of both types of reactions are the same, you won’t be able to tell if you’re having an anaphylactic reaction. Anaphylactic reactions are life-threatening, so don’t wait to get treatment. 

Once your allergic reaction is under control, you can talk to an allergist about getting formal testing to see which type of allergic reaction you have.

What can you take if you’re allergic to ibuprofen?

If you’re allergic to ibuprofen, you still have options for OTC pain relievers. 

No matter which type of allergic reaction you have, you can still take acetaminophen (Tylenol) and acetaminophen-containing medications. Acetaminophen isn’t an NSAID, so it won’t trigger either type of reaction.

If you had an immune-mediated reaction to ibuprofen you may also be able to take aspirin and naproxen. But your allergist will do an allergy test to make sure they’re safe. 

If you had a nonimmune-mediated reaction, you probably won’t be able to use aspirin or naproxen. But you can take celecoxib if acetaminophen doesn’t provide enough relief. 

Do ibuprofen allergies go away?

Ibuprofen and other NSAID allergies will not go away. But some people can try desensitization. This is a process where someone takes progressively larger doses of NSAIDs under medical supervision. After desensitization they can safely take NSAIDs again. 

Since this is a time-intensive process, experts usually only recommend it for people who need to take NSAIDs every day. 

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Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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