Background Non-steroidal anti-inflammatory drug (NSAID)-triggered urticaria and angioedema occurrs in up to 3% of the population. The tolerance to new COX-2 selective inhibitors in intolerant patients has not been determined.
Objectives To study the clinical tolerance to Rofecoxib and Celecoxib in patients sensitive to conventional NSAIDs who develop urticaria and/or angioedema when exposed to these drugs.
Methods Sixty three subjects (female 44, male 19, mean age 33.0 ± 16.7 years, range 11 – 74 years) with challenge-proved urticaria/angioedema were studied. These patients were challenged by means of the single-blinded oral method, controlled with placebo.
Results Positive challenges were observed in 4 out of 53 subjects challenged with Rofecoxib (7.5%) and in 13 out of 47 individuals submitted to oral provocation with Celecoxib (27.6%) (p = 0.01).
Conclusion We conclude that: 1) The clinical tolerance to selective COX-2 inhibitors in NSAID-sensitive patients with skin manifestations differs between new drugs, which may be due to different degrees of enzyme selectivity or to other, not yet determined reasons.2) COX-1 inhibition would be involved in the production of cutaneous adverse reactions to NSAIDs.3) Controlled oral challenges are indicated especially for the management of sensitive individuals with chronic inflammatory and/or painful diseases.
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