title: Are drug provocation tests still necessary to test the safety of COX-2 inhibitors in patients with cross-reactive NSAID hypersensitivity?
abstract: BACKGROUND
  COX-2 inhibitors are safe alternatives in patients with cross-reactive non-steroidal anti-inflammatory drug (NSAID) hypersensitivity. These drugs are recommended to these patients after negative drug provocation tests (DPTs). However, cumulative data on encouraging results about the safety of COX-2 inhibitors in the majority of these patients bring the idea as to whether a DPT is always mandatory for introducing these drugs in all patients with cross-reactive NSAID hypersensitivity.
  
  
  OBJECTIVE
  To document the safety of COX-2 inhibitors currently available and to check whether or not any factor predicts a positive response.
  
  
  METHODS
  This study included the retrospective analysis of cases with cross-reactive NSAID hypersensitivity who underwent DPTs with COX-2 inhibitors in order to find safe alternatives. DPTs were single-blinded and placebo controlled.
  
  
  RESULTS
  The study group consisted of 309 patients. COX-2 inhibitors were well tolerated in the majority of the patients [nimesulide: 91.9%; meloxicam: 90.2%; rofecoxib: 94.9%; and celecoxib: 94.9%)]. Twenty-five patients (30 provocations) reacted to COX-2 inhibitors. None of the factors were found be associated with positive response.
  
  
  CONCLUSIONS
  Our results suggest to follow the traditional DPT method to introduce COX-2 inhibitors for finding safe alternatives in all patients with cross-reactive NSAID hypersensitivity before prescription as uncertainty of any predictive factor for a positive response continues. However, these tests should be performed in hospital settings in which emergency equipment and experienced personnel are available.
authors.affiliation: Department of Chest Disease, Division of Immunology and Allergy, School of Medicine, Ankara University, Ankara, Turkey. gulfemcelik@gmail.com
authors.forename: G E
authors.initials: GE
authors.lastname: Çelik
authors.forename: F Ö
authors.initials: FÖ
authors.lastname: Erkekol
authors.forename: Ö
authors.initials: Ö
authors.lastname: Aydın
authors.forename: Y S
authors.initials: YS
authors.lastname: Demirel
authors.forename: Z
authors.initials: Z
authors.lastname: Mısırlıgil
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D000799:Angioedema / Q000139:chemically induced*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects; D001986:Bronchial Spasm / Q000139:chemically induced*; D000068579:Celecoxib; D015897:Comorbidity; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000175:diagnosis / Q000453:epidemiology; D007159:Immunologic Tests; D007783:Lactones; D008297:Male; D000077239:Meloxicam; D011237:Predictive Value of Tests; D011720:Pyrazoles; D012130:Respiratory Hypersensitivity / Q000453:epidemiology; D012189:Retrospective Studies; D016037:Single-Blind Method; D012882:Skin Tests; D013449:Sulfonamides; D013450:Sulfones; D013843:Thiazines; D013844:Thiazoles; D019564:Unnecessary Procedures; D014581:Urticaria / Q000139:chemically induced*
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D007783:Lactones; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; D013843:Thiazines; D013844:Thiazoles; C116926:rofecoxib; D000068579:Celecoxib; D001241:Aspirin; C012655:nimesulide; D000077239:Meloxicam