Safety of COX-2 inhibitors in asthma patients with aspirin hypersensitivity.
OBJECTIVE
To review the safety of cyclooxygenase-2 (COX-2) inhibitors in asthma patients with aspirin hypersensitivity.


METHODS
Clinical studies were identified using MEDLINE (1966-September 2002). Key search terms included cyclooxygenase inhibitors, aspirin, asthma, and hypersensitivity. English-language articles were identified and included. References from the identified articles were also reviewed.


RESULTS
The literature provides information regarding the safety of COX-2 inhibitors in asthma patients with aspirin-exacerbated respiratory disease (AERD). The mechanism of AERD involves inhibition of cyclooxygenase, particularly COX-1. Inhibition of COX-1 causes an increased production of certain inflammatory mediators, which results in the reactions seen with AERD. Considering this mechanism, COX-2 inhibitors may be an alternative to aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) in a patient with AERD. This article analyzes 4 studies to evaluate the safety of COX-2 inhibitors in this population.


RESULTS
The 4 studies evaluated included a total of 172 patients with AERD. All patients included demonstrated intolerance to aspirin or NSAIDs and tolerated the selective COX-2 inhibitor administered.


CONCLUSIONS
COX-2 inhibitors provide a potentially safe alternative for treatment of inflammatory conditions in patients with AERD.
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D001249:Asthma / Q000139:chemically induced* / Q000188:drug therapy / Q000517:prevention & control*; D000068579:Celecoxib; D051546:Cyclooxygenase 2; D004342:Drug Hypersensitivity / Q000150:complications / Q000209:etiology*; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors*; D007783:Lactones / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D008565:Membrane Proteins; D015201:Meta-Analysis as Topic; D011451:Prostaglandin-Endoperoxide Synthases; D011720:Pyrazoles; D013449:Sulfonamides / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D013450:Sulfones
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007527:Isoenzymes; D007783:Lactones; D008565:Membrane Proteins; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D000068579:Celecoxib; D001241:Aspirin