Can NSAIDs-allergic patients use COX-2 inhibitors?

NSAIDs are the drugs most commonly involved in hypersensitivity drug reactions. http://buff.ly/1tI92CZ

Parecoxib is the first injectable cyclooxygenase 2 selective (COX-2) inhibitor indicated for the treatment of acute postoperative pain. It is marketed as Dynastat in the European Union.

Can NSAIDs-allergic patients use COX-2 inhibitors?

The following study may be helpful in answering this question.

Seventy nine patients with history of urticaria or angioedema after use of NSAIDs were enrolled in a single-blind challenge with parecoxib, 40 mg. No reaction to placebo or to parecoxib was observed in any patients.

Authors concluded that parecoxib could be safely proposed as an alternative (after a prior challenge) in patients with previous hypersensitive reactions to NSAIDs who require an IV analgesic drug perioperatively.

However, 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. Allergy, 2011.


Mind map of adverse reactions to drugs. See other related mind maps on AllergyCases.org.

What are the best alternative therapeutic choices for a patient who develops urticaria when taking ibuprofen?

(A) Keterolac
(B) Naproxen
(C) Celecoxib
(D) Aspirin
(E) Tylenol
(F) Motrin

Answers: C and E.

References:

Safety of parecoxib in patients with nonsteroidal anti-inflammatory drug-induced urticaria or angioedema. Annals of Allergy, Asthma and Immunology, 2008, vol. 100, no. 1, pp. 82 - 85.
Drug Hypersensitivity. Allergy Cases.
The Kounis-Zavras syndrome with the Samter-Beer triad http://goo.gl/g7qGh
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. Allergy, 2011.
How Can We Better Classify NSAID Hypersensitivity Reactions – Validation from a Large Database  http://goo.gl/sal36
Image source: Wikipedia

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