[Tolerance to coxibs in patients with intolerance to non-steroidal anti-inflammatory drugs (NSAIDs)].
OBJECTIVE
Non-steroidal anti-inflammatory drugs (NSAIDs) frequently cause pseudoallergic reactions. Recognition of two different prostaglandin synthase iso-enzymes led to the development of the so-called coxibs preferentially inhibiting cyclooxygenase-2. We studied tolerability of valdecoxib preferentially inhibitng cyclooxygenase-2 in patients with a history of intolerance to NSAIDs.


METHODS
41 patients (30 female, 11male, age 14-74 years) with a history of intolerance to NSAIDs underwent scratch tests with these drugs and valdecoxib, followed by oral challenge with valdecoxib (maximum single dose: 20 mg; cumulative dose: 35mg) in a double-blind, placebo-controlled manner.


RESULTS
The history of intolerance to NSAID comprised urticaria as the leading symptom (n = 26), followed by angioedema (n = 11) and anaphylactoid shock (n = 4). 21 patients reported reactions to only one NSAID, 15 identified 2 different triggering drugs, and 5 patients showed reactions to 3 different NSAIDs. Acetylsalicylic acid (n = 20) and diclofenac (n = 12) were the most frequent causative drugs. Upon oral challenge with valdecoxib, one patient developed generalized urticaria within 30 minutes following the last dose of valdecoxib; symptoms resolved after i. v. injection of 2 mg clemastine and 250 mg prednisolone. All other patients tolerated the oral challenge without adverse effects.


CONCLUSIONS
Our results are in line with previous studies suggesting that preferential cyclooxygenase-2-inhibitors may safely be used by patients with known intolerance to NSAIDs.
Boehncke
S
S
Zentrum der Inneren Medizin, Abteilung Endokrinologie. Boehncke@em.uni-frankfurt.de
Boehncke
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WH
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced; D000799:Angioedema / Q000139:chemically induced; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004342:Drug Hypersensitivity; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012882:Skin Tests; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects*; D014581:Urticaria / Q000139:chemically induced; D000096926:Benzenesulfonamides
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D007555:Isoxazoles; D013449:Sulfonamides; C406224:valdecoxib; D000096926:Benzenesulfonamides