title: Cetirizine premedication prevents acute urticaria induced by weak COX-1 inhibitors in multiple NSAID reactors.
abstract: BACKGROUND
  In multiple NSAID reactors, intolerance to weak COX-1 inhibitors may pose relevant therapeutic problems when painful, febrile or rheumatic disorders co-exist.
  
  
  OBJECTIVE
  To assess whether pre-medication with a second generation antihistamine is able to prevent urticaria induced by "alternative" NSAIDs.
  
  
  METHODS
  87 with a history of urticaria following the administration of multiple, chemically unrelated NSAID underwent 250 oral tolerance tests with alternative drugs exerting little or no COX-1 inhibition (paracetamol, coxibs, nimesulide, tramadol). Twenty-eight challenges scored positive in 21 subjects: 8, 5, 9, and 6 reactions were induced by paracetamol, tramadol, coxibs, and nimesulide, respectively. Thirteen of 21 underwent a new oral challenge with the offending drug(s) 2-6 hours after taking cetitrizine 10 mg.
  
  
  RESULTS
  All the drugs were tolerated on re-challenge except paracetamol that was not tolerated in 2/4 cases.
  
  
  CONCLUSIONS
  In most cases urticaria induced by alternative drugs exerting little or no COX 1-inhibition is slight, and can be adequately prevented by oral antihistamine pre-medication. These observations open new opportunities for patients with multiple NSAIDs intolerance that have to treat painful or febrile conditions or rheumatic disorders.
authors.affiliation: Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano (MI), Italy.
authors.forename: R
authors.initials: R
authors.lastname: Asero
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D017332:Cetirizine / Q000627:therapeutic use*; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects; D005260:Female; D039563:Histamine H1 Antagonists, Non-Sedating / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication; D014581:Urticaria / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D039563:Histamine H1 Antagonists, Non-Sedating; D017332:Cetirizine