NSAID Intolerance Indicative of Intolerance to Etoricoxib

Patients with urticaria or angioedema reactions to NSAIDs may also be intolerant to etoricoxib

MONDAY, Aug. 22 (HealthDay News) -- Patients with urticaria and/or angioedema with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) may also be intolerant to etoricoxib, according to a study published online Aug. 11 in Allergy.

Inmaculada Doña, M.D., from the Carlos Haya Hospital in Málaga, Spain, and colleagues investigated tolerance to etoricoxib in 252 patients with urticaria and/or angioedema caused by hypersensitivity due to cross-intolerance to NSAIDs. All of the patients had a confirmed diagnosis by provocation to an alternative NSAID in addition to their clinical history. Group A was comprised of patients with cross-intolerance to NSAIDs and intolerance to acetaminophen, and Group B patients had cross-intolerance to NSAIDs and good tolerance to acetaminophen. Etoricoxib was administered to all of Group A patients and to a representative subset of Group B. Serum tryptase levels were determined in the event of a positive response, and skin biopsy was performed on five patients in each group.

The investigators found that ibuprofen was the most commonly implicated NSAID, followed by acetylsalicylic acid. The most common symptom of intolerance was urticaria, followed by angioedema, with most patients developing symptoms within one hour. Intolerance to etoricoxib was found in 25 percent of the patients in group A and 6 percent in group B. Mast cell activation with the release of tryptase to the extracellular space but without an increase in serum tryptase levels was revealed by skin biopsy.

"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," the authors write. "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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