Tolerance to celecoxib in patients with a history of adverse reactions to nonsteroidal anti-inflammatory drugs.
BACKGROUND: Adverse reactions to nonsteroidal antiinflammatory drugs (NSAIDs) are frequently reported, particularly among asthmatic patients. To date, there is no causal treatment available apart from tolerance induction. Therefore, the search for safe alternative drugs is of pivotal importance in clinical practice. OBJECTIVE: The aim of our prospective study was to investigate the tolerance to celecoxib, a selective cyclooxygenase-2 inhibitor, in a large group of patients with positive case history of NSAID intolerance in comparison to paracetamol and nimesulide. METHODS: 106 NSAID-sensitive patients, 46 (43.4%) of whom had experienced reactions only to one NSAID (single hypersensitivity), 60 (56.6%) to several NSAIDs (multiple hypersensitivity), were included in a single-blinded drug challenge protocol with cumulative doses of 175 mg of celecoxib, 875 mg of paracetamol and 175 mg of nimesulide. Objective and subjective symptoms during challenge were documented. RESULTS: Of 261 challenges in 106 patients, 31 challenges were positive: 5 of 106 (4.7%) for celecoxib, 10 of 64 (15.6%) for paracetamol and 16 of 91 for nimesulide (17.6%). Adverse reactions to celecoxib were mainly mild in character: three patients reported subjective symptoms including generalised pruritus and thoracic oppression, whereas two patients reacted with angio-oedema. CONCLUSIONS: Our results demonstrate that celecoxib is well tolerated by the majority of patients with NSAID intolerance. However, since adverse reactions to celecoxib cannot be ruled out completely, a controlled oral challenge test is still mandatory for proper management of patients with NSAID intolerance.