title: Response to a selective COX-2 inhibitor in patients with urticaria/angioedema induced by nonsteroidal anti-inflammatory drugs.
abstract: BACKGROUND
  In subjects with hypersensitivity reactions with cross-intolerance to nonsteroidal anti-inflammatory drugs (NSAIDs), tolerance to selective COX-2 inhibitors has not been evaluated in large series of well-phenotyped cases.
  
  
  METHODS
  We evaluated 252 patients with urticaria and/or angioedema caused by hypersensitivity owing to cross-intolerance to NSAIDs. In addition to the clinical history, diagnosis was confirmed by provocation to an alternative NSAID. Two groups were considered: (A) patients with cross-intolerance to NSAIDs and intolerance to paracetamol and (B) patients with cross-intolerance to NSAIDs and good tolerance to paracetamol. Etoricoxib was administered to Group A patients and to a representative sample of Group B patients. In the event of a positive response, serum tryptase levels were determined and skin biopsy was performed in five patients in each group.
  
  
  RESULTS
  Ibuprofen was the most commonly implicated drug, followed by acetylsalicylic acid (ASA). Urticaria was the most common manifestation, followed by angioedema. Most of the patients developed symptoms within 1 h. Twenty-five percent in Group A (n = 47) and 6% in Group B (n = 50) were intolerant to etoricoxib. Skin biopsy showed mast cell activation with the release of tryptase to the extracellular space but without the increase in serum tryptase levels.
  
  
  CONCLUSIONS
  Selective COX-2 inhibitors may be unsafe in subjects with urticaria and/or angioedema caused by hypersensitivity reactions to NSAIDs with cross-intolerance if they are intolerant to paracetamol. A quarter of patients who were intolerant to this drug were also intolerant to etoricoxib. In subjects with hypersensitivity to NSAIDs and intolerance to paracetamol, selective COX-2 inhibitors should be administered as a controlled, incremental dose provocation test to assess tolerance.
authors.affiliation: Allergy Service, Carlos Haya Hospital, Málaga, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Doña
authors.forename: N
authors.initials: N
authors.lastname: Blanca-López
authors.forename: L R
authors.initials: LR
authors.lastname: Jagemann
authors.forename: M J
authors.initials: MJ
authors.lastname: Torres
authors.forename: C
authors.initials: C
authors.lastname: Rondón
authors.forename: P
authors.initials: P
authors.lastname: Campo
authors.forename: A I
authors.initials: AI
authors.lastname: Gómez
authors.forename: J
authors.initials: J
authors.lastname: Fernández
authors.forename: J J
authors.initials: JJ
authors.lastname: Laguna
authors.forename: A
authors.initials: A
authors.lastname: Rosado
authors.forename: M
authors.initials: M
authors.lastname: Blanca
authors.forename: G
authors.initials: G
authors.lastname: Canto
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000799:Angioedema / Q000139:chemically induced* / Q000150:complications; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D000077613:Etoricoxib; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000209:etiology; D007052:Ibuprofen / Q000009:adverse effects; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects*; D016037:Single-Blind Method; D013450:Sulfones / Q000008:administration & dosage / Q000009:adverse effects*; D014581:Urticaria / Q000139:chemically induced* / Q000150:complications; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D011725:Pyridines; D013450:Sulfones; D000082:Acetaminophen; D001241:Aspirin; D007052:Ibuprofen; D000077613:Etoricoxib