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Are drug provocation tests still necessary to test the safety of COX-2 inhibitors in patients with cross-reactive NSAID hypersensitivity?
- Source :
-
Allergologia et immunopathologia [Allergol Immunopathol (Madr)] 2013 May-Jun; Vol. 41 (3), pp. 181-8. Date of Electronic Publication: 2012 Sep 30. - Publication Year :
- 2013
-
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.<br />Objective: To document the safety of COX-2 inhibitors currently available and to check whether or not any factor predicts a positive response.<br />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.<br />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.<br />Conclusion: 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.<br /> (Copyright © 2012 SEICAP. Published by Elsevier Espana. All rights reserved.)
- Subjects :
- Adult
Analgesics, Non-Narcotic adverse effects
Aspirin adverse effects
Celecoxib
Comorbidity
Drug Hypersensitivity diagnosis
Drug Hypersensitivity etiology
Female
Humans
Hypersensitivity, Immediate diagnosis
Hypersensitivity, Immediate epidemiology
Lactones
Male
Meloxicam
Predictive Value of Tests
Pyrazoles
Respiratory Hypersensitivity epidemiology
Retrospective Studies
Single-Blind Method
Skin Tests
Sulfonamides
Sulfones
Thiazines
Thiazoles
Angioedema chemically induced
Anti-Inflammatory Agents, Non-Steroidal adverse effects
Bronchial Spasm chemically induced
Cyclooxygenase 2 Inhibitors adverse effects
Drug Hypersensitivity prevention & control
Immunologic Tests
Unnecessary Procedures
Urticaria chemically induced
Subjects
Details
- Language :
- English
- ISSN :
- 1578-1267
- Volume :
- 41
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Allergologia et immunopathologia
- Publication Type :
- Academic Journal
- Accession number :
- 23031659
- Full Text :
- https://doi.org/10.1016/j.aller.2012.03.006