title: Tolerability to new COX-2 inhibitors in NSAID-sensitive patients with cutaneous reactions.
abstract: BACKGROUND
  The safety of new anti-inflammatory drugs in patients intolerant to classic cyclooxygenase (COX) inhibitors with urticaria and angioedema has not been determined.
  
  
  OBJECTIVE
  To investigate the clinical tolerance to COX-2 inhibitors in patients with cutaneous symptoms attributable to classic nonsteroidal anti-inflammatory drugs (NSAIDs).
  
  
  METHODS
  Patients with urticaria or angioedema triggered by NSAIDs were challenged with COX-2 inhibitors by the single-blinded, placebo-controlled oral method.
  
  
  RESULTS
  One hundred ten NSAID-sensitive patients were submitted to 184 oral challenges with COX-2 inhibitors. Eighty-two patients (74.5%) were cross-reactors and 28 patients (25.4%) were single reactors. Reaction rates for COX-2 inhibitors were 21.3% for nimesulide, 17.3% for meloxicam, 33.3% for celecoxib, and 3.0% for rofecoxib.
  
  
  CONCLUSIONS
  Some COX-2 inhibitors, such as rofecoxib, are relatively safe in NSAID-sensitive patients with urticaria or angioedema. However, the tolerance profile varies with the drug, which might be related to a differential selectivity of the drug for COX-1 and COX-2. COX-1 inhibition would represent a major mechanism for cutaneous adverse reactions to NSAIDs. Controlled oral provocation with new NSAIDs is useful for the proper management of patients sensitive to classic NSAIDs requiring analgesic and anti-inflammatory treatment.
authors.affiliation: Allergy-Immunology Service, Centro Médico-Docente La Trinidad, Caracas, Venezuela. malsan@cantv.net
authors.forename: M
authors.initials: M
authors.lastname: Sánchez Borges
authors.forename: A
authors.initials: A
authors.lastname: Capriles-Hulett
authors.forename: F
authors.initials: F
authors.lastname: Caballero-Fonseca
authors.forename: C R
authors.initials: CR
authors.lastname: Pérez
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000276:immunology
chemical_list: D016861:Cyclooxygenase Inhibitors