Tolerancia a inhibidores selectivos de la ciclooxigenasa 2 en casos de alergia o intolerancia a los antiinflamatorios no esteroideos convencionales: experiencia en un centro.

Abstract

Background: Patients with non-steroidal anti-inflammatory drugs (NSAID) sensitivity have a low prevalence of cross-reaction to COX-2 selective inhibitors. Oral drug challenge with these agents can be done in a clinical setting with a good safety profile. Objective: To evaluate tolerance to COX-2 selective inhibitors in patients with history of NSAID sensitivity using a shortened oral drug challenge. Methods: Patients with NSAID sensitivity were included. A shortened oral drug challenge with a COX-2 selective inhibitor (meloxicam or etoricoxib) was carried out. The challenge was considered positive if any of the following symptoms appeared: urticaria, rhinoconjunctivitis, angioedema, anaphylaxis or bronchospasm, the latter defined as a fall in FEV1 equal or greater than 20%. Results: Fifty-four patients were enrolled (78% were women), with a mean age of 39.6 years (range, 13 to 70 years). Forty three patients were challenged with meloxicam (79.6%) and 11 with etoricoxib (20.4%). Forty nine patients tolerated the drug challenge (90.7%), and only five patients (all challenged with meloxicam) developed a reaction (9.3%): urticaria in two, urticaria plus angioedema in one, and broncospasm in other two. From these, three were rechallenged with etoricoxib and all of them tolerated it. Conclusion: Most of the subjects with NSAID sensitivity tolerated a COX-2 selective inhibitor by means of a shortened oral drug challenge. This is the first cohort of patients with NSAID sensitivity and its tolerance to COX-2 selective inhibitors published in our country. (English) [ABSTRACT FROM AUTHOR]