Safety of etoricoxib, a new cyclooxygenase 2 inhibitor, in patients with nonsteroidal anti-inflammatory drug-induced urticaria and angioedema.
BACKGROUND
The use of selective inhibitors of cyclooxygenase 2 (COX-2) has been shown to be safe in patients with aspirin-induced asthma. However, a few individuals with cutaneous reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) experience urticaria or angioedema when challenged with various coxibs.


OBJECTIVE
To investigate the clinical tolerance of NSAID-sensitive individuals to the selective COX-2 inhibitors etoricoxib and celecoxib.


METHODS
Patients with NSAID-induced urticaria or angioedema were challenged in a double-masked, placebo-controlled design protocol with etoricoxib (120 mg) and celecoxib (200 mg). Cutaneous, respiratory, and general symptoms; vital signs; and pulmonary function were monitored hourly for 3 hours.


RESULTS
Fifty-eight patients (46 females and 12 males) with a mean +/- SD age of 31.7 +/- 14.1 years (range, 13-66 years) who showed urticaria or angioedema when challenged with NSAIDs were included in this study. A cutaneous clinical pattern was observed in 34 patients (59%), and a mixed pattern (cutaneous and respiratory) was seen in 24 (41%). Celecoxib provocation of 54 patients induced urticaria in 3, urticaria and angioedema in 2, and urticaria, rhinorrhea, and conjunctival erythema in 1 (reaction rate, 11.1%). Etoricoxib challenges performed in 56 patients induced urticaria in 3 and angioedema in 1 (reaction rate, 7.1%).


CONCLUSIONS
These results confirm that most NSAID-sensitive individuals with cutaneous reactions to classic NSAIDs will tolerate specific COX-2 inhibitors, supporting the use of thesedrugs after careful oral provocation in such patients.
Sánchez-Borges
Mario
M
Allergy and Clinical Immunology Service, Centro Medico-Docente La Trinidad, Caracas, Venezuela. malsan@cantv.net
Caballero-Fonseca
Fernan
F
Capriles-Hulett
Arnaldo
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000799:Angioedema / Q000139:chemically induced*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000068579:Celecoxib; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D004342:Drug Hypersensitivity / Q000209:etiology; D000077613:Etoricoxib; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000009:adverse effects / Q000494:pharmacology; D011725:Pyridines / Q000009:adverse effects* / Q000494:pharmacology; D013449:Sulfonamides / Q000009:adverse effects / Q000494:pharmacology; D013450:Sulfones / Q000009:adverse effects* / Q000494:pharmacology; D014581:Urticaria / Q000139:chemically induced*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D011720:Pyrazoles; D011725:Pyridines; D013449:Sulfonamides; D013450:Sulfones; D000068579:Celecoxib; D000077613:Etoricoxib