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Li L, Laidlaw T. Cross-reactivity and tolerability of celecoxib in adult patients with NSAID hypersensitivity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2891-2893.e4. [PMID: 31100553 DOI: 10.1016/j.jaip.2019.04.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/22/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Lily Li
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Brigham and Womens Hospital, Boston, MA.
| | - Tanya Laidlaw
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Brigham and Womens Hospital, Boston, MA
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Corzo JL, Zambonino MA, Muñoz C, Mayorga C, Requena G, Urda A, Gallego C, Blanca M, Torres MJ. Tolerance to COX-2 inhibitors in children with hypersensitivity to nonsteroidal anti-inflammatory drugs. Br J Dermatol 2014; 170:725-9. [PMID: 24116718 DOI: 10.1111/bjd.12674] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
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. OBJECTIVES 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.
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Affiliation(s)
- J L Corzo
- Pediatric Service, Carlos Haya Hospital/IBIMA, Plaza del Hospital Civil s/n, pabellón 5, sótano, 29009, Malaga, Spain
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Abstract
Angioedema is the end result of deep dermal, subcutaneous and/or mucosal swelling, and is potentially a life-threatening condition in cases where the pharynx or larynx is involved. Drug-induced angioedema has been reported to occur in response to a wide range of drugs and vaccines. Drug-induced angioedema, like other cutaneous drug reactions, has been reported to be most frequently elicited by beta-lactam antibiotics and non-steroidal anti-inflammatory drugs, although reliable data from epidemiologic studies are scarce. Recent reports suggested an increasing role of angiotensin-converting enzyme inhibitors (ACEIs) in the causation of life-threatening angioedema. ACEI-related angioedema is never accompanied by urticaria and occurs via a kinin-dependent mechanism. ACEI-related angioedema not only can start years after beginning the treatment, but it can then recur irregularly while under that treatment. Furthermore, allergy tests are unreliable for the diagnosis of ACEI-related angioedema, and so the relationship between angioedema and ACEIs is often missed and consequently quite underestimated. Accordingly, better understanding of the kinin-dependent mechanism, which is particular to angioedema, is necessary for the appropriate management of drug-induced angioedema.
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Affiliation(s)
- Naoko Inomata
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. −cu.ac.jp
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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; 66:1428-33. [PMID: 21834936 DOI: 10.1111/j.1398-9995.2011.02684.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- I Doña
- Allergy Service, Carlos Haya Hospital, Málaga, Spain
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Moneret-Vautrin DA, Codreanu F, Drouet M, Plaud B, Karila C, Valfrey J, Debaene B, Malinovsky JM, Mertes JM. [Allergologic screening and management of patients with previous self-reported hypersensitivity reactions. Société française d'anesthésie et réanimation. Société française d'allergologie]. ACTA ACUST UNITED AC 2011; 30:246-63. [PMID: 21397445 DOI: 10.1016/j.annfar.2011.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D-A Moneret-Vautrin
- Service de médecine interne, immunologie clinique et allergologie, hôpital central, avenue du Maréchal de-Lattre-de-Tassigny, Nancy cedex, France.
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Valero A, Sánchez-López J, Bartra J, Serrano C, Muñoz-Cano R, Roca J, Picado C. Safety of parecoxib in asthmatic patients with aspirin-exacerbated respiratory disease. Int Arch Allergy Immunol 2011; 156:221-3. [PMID: 21597303 DOI: 10.1159/000322841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 11/03/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) affects a subset of patients with asthma. Cyclooxygenase 2 inhibitors are a safe alternative in patients with AERD. Parecoxib is the first cyclooxygenase 2 selective drug for parenteral administration, especially useful after surgery thanks to its analgesic power. The aim of the study is to assess the tolerance of parecoxib (Dynastat; Pfizer) given by intramuscular route in patients with AERD. METHODS Patients evaluated were referred to the Pneumology and Respiratory Allergy Department of the Hospital Clinic (Barcelona, Spain) for asthma exacerbations precipitated by 2 or more different non-steroidal anti-inflammatory drugs (NSAIDs). AERD was confirmed by a nasal challenge test with aspirin. Patients were challenged with parecoxib, and urine samples were collected to measure the leukotriene E(4) concentration. RESULTS Ten patients were challenged with parecoxib. No symptoms were reported with any of the administered doses, and there were no signs of immediate or delayed hypersensitivity. There were no alterations in the forced expiratory volume in 1 s or in acoustic rhinometry measurements. No significant differences between leukotriene E(4) levels were detected. CONCLUSION The drug was well tolerated by all patients, with no adverse reactions. This lack of reactions found in our study supports the fact that parecoxib could be a safe alternative in postsurgery analgesia in NSAID-intolerant asthma patients.
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Affiliation(s)
- Antonio Valero
- Department of Pneumology and Respiratory Allergy, Allergy Unit, Hospital Clinic, Barcelona, Spain.
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Viola M, Maietta G, Quaratino D, Rumi G, Gaeta F, Romano A. Selective hypersensitivity to nimesulide. Allergy 2008; 63:624-6. [PMID: 18394140 DOI: 10.1111/j.1398-9995.2008.01669.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Viola
- Unità di Allergologia, Complesso Integrato Columbus, Via G. Moscati 3100168 Rome, Italy
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Colanardi MC, Nettis E, Traetta P, Daprile C, Fitto C, Aloia AM, Di Leo E, Ferrannini A, Vacca A. Safety of parecoxib in patients with nonsteroidal anti-inflammatory drug-induced urticaria or angioedema. Ann Allergy Asthma Immunol 2008; 100:82-5. [PMID: 18254487 DOI: 10.1016/s1081-1206(10)60409-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parecoxib is the first injectable cyclooxygenase 2 selective inhibitor indicated for the treatment of acute postoperative pain. OBJECTIVE To describe the results of a challenge with parecoxib in patients with a history of urticaria or angioedema to 1 or more nonsteroidal anti-inflammatory drugs (NSAIDs). METHODS The study was performed from October 1, 2006, through March 31, 2007, with 79 patients who historically had experienced urticaria or angioedema after use of NSAIDs. The patients underwent a single-blind challenge with parecoxib, 40 mg. RESULTS No reaction to placebo was observed in any patient. Similarly, no reaction to parecoxib was observed in any patients in the single-class or multiple-class intolerance group. CONCLUSION Our report demonstrates that parecoxib does not induce cross-reactivity in patients with a history of urticaria or angioedema. Hence, this finding suggests that this drug could be safely proposed as an alternative (but only after a prior challenge) in patients with previous hypersensitive reactions to NSAIDs, even if there are added risk factors such as atopy and antimicrobial allergy, who require an analgesic drug perioperatively.
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Affiliation(s)
- Maria Cristina Colanardi
- Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari, Bari, Italy
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Colanardi M, Nettis E, Traetta P, Delle Donne P, Ferrannini A, Vacca A. Parecoxib as an Alternative in COX-2 Hypersensitivity. Int J Immunopathol Pharmacol 2008; 21:233-5. [DOI: 10.1177/039463200802100127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The group of non-steroidal anti-inflammatory drugs (NSAIDs) is commonly involved in hypersensitivity reactions. In clinical practice the physician is often faced with the need to choose an alternative anti-inflammatory agent for a patient who has suffered a hypersensitivity reaction to a NSAID. The most common approach to choosing the safest NSAID is to perform a challenge test. Parecoxib is the first injectable COX-2 selective inhibitor indicated for the treatment of acute postoperative pain. The authors report the case of a patient with a history of cutaneous adverse reactions to different classes of NSAIDs, including selective COX-2 inhibitors, who underwent and tolerated challenge with parecoxib.
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Affiliation(s)
- M.C. Colanardi
- Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari, Italy
| | - E. Nettis
- Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari, Italy
| | - P. Traetta
- Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari, Italy
| | - P. Delle Donne
- Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari, Italy
| | - A. Ferrannini
- Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari, Italy
| | - A. Vacca
- Department of Medical Clinic, Immunology and Infectious Diseases, Division of Allergy and Clinical Immunology, University of Bari, Italy
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Weberschock TB, Müller SM, Boehncke S, Boehncke WH. Tolerance to coxibs in patients with intolerance to non-steroidal anti-inflammatory drugs (NSAIDs): a systematic structured review of the literature. Arch Dermatol Res 2007; 299:169-75. [PMID: 17492455 PMCID: PMC1910889 DOI: 10.1007/s00403-007-0757-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 04/07/2007] [Indexed: 11/25/2022]
Abstract
Adverse events triggered by non-steroidal anti-inflammatory drugs (NSAIDs) are among the most common drug-related intolerance reactions in medicine; they are possibly related to inhibition of cyclooxygenase-1. Coxibs, preferentially inhibiting cyclooxygenase-2, may therefore represent safe alternatives in patients with NSAID intolerance. We reviewed the literature in a systematic and structured manner to identify and evaluate studies on the tolerance of coxibs in patients with NSAID intolerance. We searched MEDLINE (1966–2006), the COCHRANE LIBRARY (4th Issue 2006) and EMBASE (1966–2006) up to December 9, 2006, and analysed all publications included using a predefined evaluation sheet. Symptoms and severity of adverse events to coxibs were analysed based on all articles comprising such information. Subsequently, the probability for adverse events triggered by coxibs was determined on analyses of double-blind prospective trials only. Among 3,304 patients with NSAID intolerance, 119 adverse events occurred under coxib medication. All adverse events, except two, have been allergic/urticarial in nature; none was lethal, but two were graded as life-threatening (grade 4). The two non-allergic adverse events were described as a grade 1 upper respiratory tract haemorrhage, and a grade 1 gastrointestinal symptom, respectively. In 13 double-blind prospective studies comprising a total of 591 patients with NSAID intolerance, only 13 adverse reactions to coxib provocations were observed. The triggering coxibs were rofecoxib (2/286), celecoxib (6/208), etoricoxib (4/56), and valdecoxib (1/41). This review documents the good tolerability of coxibs in patients with NSAID intolerance, for whom access to this class of drugs for short-term treatment of pain and inflammation is advantageous.
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Affiliation(s)
- Tobias Bernd Weberschock
- Department of Dermatology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Sylke-Monina Müller
- Department of Dermatology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Sandra Boehncke
- Department of Internal Medicine, Section for Endocrinology, Metabolism, and Diabetology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Wolf-Henning Boehncke
- Department of Dermatology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Viola M, Quaratino D, Gaeta F, Caruso C, Valluzzi R, Romano A. Etoricoxib tolerability in patients with hypersensitivity to nonsteroidal anti-inflammatory drugs. Int Arch Allergy Immunol 2007; 143:103-8. [PMID: 17228166 DOI: 10.1159/000098658] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 10/24/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly observed, particularly among patients with chronic urticaria or asthma. The identification of a safe and reliable alternative is a frequent problem in clinical practice. Our aim was to investigate the clinical tolerability of etoricoxib, a new selective cyclooxygenase-2 inhibitor, in a group of patients with well-established NSAID hypersensitivity. METHODS We assessed 31 adults (21 women and 10 men) who reported one or more adverse reactions to NSAIDs, manifested as cutaneous, respiratory or anaphylactic symptoms. Sixteen of them reported reactions to a single NSAID (single reactors) and 15 to more than one NSAID (multiple reactors); the most frequently involved drug was acetylsalicylic acid. First, each patient underwent allergologic tests (skin and/or oral challenge tests) with culprit NSAIDs and then tolerability tests with increasing doses of etoricoxib up to 120 mg. All challenges were performed under single-blind, placebo-controlled conditions. RESULTS NSAID hypersensitivity was diagnosed in all 31 patients: 3 displayed positive results to pyrazolone skin tests and the other 28 to challenges with culprit NSAIDs. None reacted to either placebos or etoricoxib. CONCLUSIONS Etoricoxib seems to be a safe alternative for patients with well-demonstrated NSAID hypersensitivity.
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Affiliation(s)
- Marinella Viola
- Department of Internal Medicine and Geriatrics, UCSC-Allergy Unit, Complesso Integrato Columbus, Rome, Italy
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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