title: Tolerance to COX-2 inhibitors in children with hypersensitivity to nonsteroidal anti-inflammatory drugs.
abstract: BACKGROUND
  Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) can affect children, with the mechanism proposed being inhibition of the cyclooxygenase enzyme-1 (COX-1). In these patients nonchemically related NSAIDs, including COX-2 inhibitors, can induce the reaction, hampering treatment of fever and inflammatory processes.
  
  
  OBJECTIVE
  To analyse retrospectively tolerance to etoricoxib, a selective COX-2 inhibitor, and to meloxicam, a preferential COX-2 inhibitor, in children with hypersensitivity to NSAIDs.
  
  
  METHODS
  Clinical records of children (aged 1-14 years) diagnosed with hypersensitivity reactions to NSAIDs from January 2006 to January 2013 were included. The diagnosis was confirmed by oral drug provocation test (DPT) with the culprit NSAIDs and acetylsalicylic acid (ASA). Tolerance to paracetamol, etoricoxib and meloxicam was also evaluated.
  
  
  RESULTS
  The study included 41 children with a positive DPT with ASA and the culprit NSAID. DPT with paracetamol and etoricoxib was negative in all children, although two (4.9%) children developed a reaction after the administration of meloxicam.
  
  
  CONCLUSIONS
  These data indicate that both etoricoxib and meloxicam are good alternatives for treatment in older children with hypersensitivity to NSAIDs.
authors.affiliation: Pediatric Service, Carlos Haya Hospital/IBIMA, Plaza del Hospital Civil s/n, pabellón 5, sótano, 29009, Malaga, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Corzo
authors.forename: M A
authors.initials: MA
authors.lastname: Zambonino
authors.forename: C
authors.initials: C
authors.lastname: Muñoz
authors.forename: C
authors.initials: C
authors.lastname: Mayorga
authors.forename: G
authors.initials: G
authors.lastname: Requena
authors.forename: A
authors.initials: A
authors.lastname: Urda
authors.forename: C
authors.initials: C
authors.lastname: Gallego
authors.forename: M
authors.initials: M
authors.lastname: Blanca
authors.forename: M J
authors.initials: MJ
authors.lastname: Torres
mesh_terms: D000293:Adolescent; D000799:Angioedema / Q000139:chemically induced; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001249:Asthma / Q000139:chemically induced; D002648:Child; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000209:etiology*; D057915:Drug Substitution; D000077613:Etoricoxib; D005260:Female; D006801:Humans; D008297:Male; D000077239:Meloxicam; D011725:Pyridines / Q000009:adverse effects*; D012189:Retrospective Studies; D013450:Sulfones / Q000009:adverse effects*; D013843:Thiazines / Q000009:adverse effects*; D013844:Thiazoles / Q000009:adverse effects*; D014581:Urticaria / Q000139:chemically induced
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D011725:Pyridines; D013450:Sulfones; D013843:Thiazines; D013844:Thiazoles; D000077239:Meloxicam; D000077613:Etoricoxib