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ORIGINAL ARTICLE
Response to a selective COX-2 inhibitor in patients with urticaria/angioedema induced by nonsteroidal anti-inflammatory drugs
Article first published online: 11 AUG 2011
DOI: 10.1111/j.1398-9995.2011.02684.x
© 2011 John Wiley & Sons A/S
Additional Information
How to Cite
Doña, I., Blanca-López, N., Jagemann, L. R., Torres, M. J., Rondón, C., Campo, P., Gómez, A. I., Fernández, J., Laguna, J. J., Rosado, A., Blanca, M. and Canto, G. (2011), Response to a selective COX-2 inhibitor in patients with urticaria/angioedema induced by nonsteroidal anti-inflammatory drugs. Allergy, 66: 1428–1433. doi: 10.1111/j.1398-9995.2011.02684.x
Publication History
- Issue published online: 7 OCT 2011
- Article first published online: 11 AUG 2011
- Accepted for publication 13 July 2011
- Abstract
- Article
- References
- Cited By
Keywords:
- cross-intolerance;
- etoricoxib;
- nonsteroidal anti-inflammatory drugs;
- urticaria
To cite this article: Doña I, Blanca-López N, Jagemann LR, Torres MJ, Rondón C, Campo P, Gómez AI, Fernández J, Laguna JJ, Rosado A, Blanca M, Canto G. Response to a selective COX-2 inhibitor in patients with urticaria/angioedema induced by nonsteroidal anti-inflammatory drugs. Allergy 2011; 66: 1428–1433.
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.
Conclusion: 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.