Tolerance to COX-2 inhibitors in children with hypersensitivity to nonsteroidal anti-inflammatory drugs


  • Funding sources This study was supported by grants from the Spanish Health Ministry Fund for Health in Spain FIS network RIRAAF (RD07/0064), PS09/02419, Junta de Andalucia (CTS 06603) and FIS (09/01768).
  • Conflicts of interest None of the authors has any conflict of interest. No funds were received for the present study. Research is part of the authors' daily activities. All authors had full access to all the data (including statistical reports) and take responsibility for the integrity of the data and the accuracy of the data analysis.



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.


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.


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.


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.


These data indicate that both etoricoxib and meloxicam are good alternatives for treatment in older children with hypersensitivity to NSAIDs.