The various non-allergic NSAID hypersensitivity syndromes affect 0.5–1.9% of the general population, with<unk>  affecting about 7% of all asthmatics and about 14% of adults with severe asthma.<unk> , which is slightly more prevalent in women, usually begins in young adulthood (twenties and thirties are the most common onset times, although children are afflicted with it and present a diagnostic problem in pediatrics) and may not include any other allergies. Most commonly the first symptom is rhinitis (inflammation or irritation of the nasal mucosa), which may manifest as sneezing, runny nose, or congestion. The disorder typically progresses to asthma, then nasal polyposis, with<unk>  sensitivity coming last. Anosmia (lack of smell) also is common, as inflammation within the nose and sinuses likely reaches the olfactory receptors. The<unk>  reactions to NSAIDs vary in severity, ranging from mild nasal congestion and eye watering to lower<unk>  symptoms including wheezing, coughing, an asthma attack, and in rare cases, anaphylaxis. In addition to the typical<unk>  reactions, about 10% of patients with<unk>  manifest skin symptoms such as urticaria and/or gastrointestinal symptoms such as abdominal pain or vomiting during their reactions to<unk> . In addition to<unk> , patients also react to other NSAIDs such as ibuprofen, and to any medication that inhibits the cyclooxygenase-1 (COX-1) enzyme, although paracetamol (acetaminophen) in low doses is generally considered safe. NSAIDs that are highly selective in blocking COX-2 and do not block its closely related paralog, COX-1, such as the COX-2 inhibitors celecoxib and rofecoxib, also are regarded as safe. Nonetheless, recent studies do find that these types of drugs, e.g. acetaminophen and celecoxib, may trigger adverse reactions in these patients; caution is recommended in using any COX inhibitors. In addition to<unk>  and NSAIDs, consumption of even small amounts of alcohol also produces uncomfortable<unk>  reactions in many patients.
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