JOMPAC
Journal of Medicine and Palliative Care

Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

eISSN: 2717-7505
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
Safety of partial selective COX-2 inhibitors in patients with cross- reactive NSAID hypersensitivity and factors affecting safety
Abstract
Aims: Partial selective COX-2 inhibitors, such as nimesulide, or meloxicam are tolerated by the majority of the patients with cross-reactive NSAID hypersensitivity. This study aimed to obtain more information about the safety of partial selective COX-2 inhibitors; nimesulide and meloxicam in non-immunologic type, cross-reactive NSAID hypersensitivity and to detect risk factors for intolerance to these drugs.
Methods: This is a retrospective study of patients with suggestive of cross-reactive NSAID hypersensitivity who admitted to our clinic over a period of 10 years. Patients who had a reliable history of immediate type NSAIDs hypersensitivity with at least 2 chemically unrelated class and/or positive ASA provocation test and who underwent alternative drug provocation test with partial selective COX-2 inhibitors (nimesulide and/or meloxicam) were included to study. Patients’ demographics, comorbidities, atopy status, duration of NSAID hypersensitivity, total number of reactions, reaction grades, clinical phenotypes, pulmonary function test parameters and results of alternative drug provocation test results are recorded. Patients with and without reactions during alternative provocation tests with nimesulide and/or meloxicam were compared in terms of these data.
Results: A total of 560 patients were included in the study, 378 (67.5%) of them were female. Allergic comorbidities were detected in 394 (72.6%) patients. Asthma, other drug allergies and nasal polyp were the most common comorbidities. Alternative drug provocation test positivity with nimesulide and/or meloxicam was detected in 50 of 560 (8.9%) patients. Provocation test positivity was 33/541 (6.1%) with nimesulide, 30/517 (5.8%) with meloxicam and 13/498 (2.3%) with both nimesulide and meloxicam. Duration of NSAID hypersensitivity was shorter and allergic comorbidities, asthma, nasal polyp and the coexistence of asthma and nasal polyp were more common in patients with a positive provocation test.
Conclusion: The partial selective COX-2 inhibitors nimesulide and meloxicam are well tolerated alternatives in patients with cross-reactive NSAID hypersensitivity. Hypersensitivity to these drugs is significantly higher in patients with asthma and/or nasal polyp than other group of cross-reactive NSAID hypersensitive patients and also in patients with a shorter duration of NSAID hypersensitivity.

Keywords : NSAID, hypersensitivity, COX-2 inhibitor, nimesulide, meloxicam, safety

Download Article


1. Torres MJ, Barrionuevo E, Kowalski M, Blanca M.Hypersensitivity reactions to nonsteroidal anti-inflammatorydrugs. Immunol Allergy Clin North Am. 2014;34(3):507-524.
2. Kowalski ML, Asero R, Bavbek S, et al. Classification and practicalapproach to the diagnosis and management of hypersensitivity tononsteroidal anti-inflammatory drugs. Allergy. 2013;68(10):1219-1232.
3. Kowalski ML, Makowska JS, Blanca M, et al. Hypersensitivity tononsteroidal anti-inflammatory drugs (NSAIDs) - classification,diagnosis and management: review of the EAACI/ENDA(#) andGA2LEN/HANNA. Allergy. 2011;66(7):818-829.
4. Nizankowska-Mogilnicka E, Bochenek G, Mastalerz L, et al.EAACI/GA2LEN guideline: aspirin provocation tests for diagnosisof aspirin hypersensitivity. Allergy. 2007;62(10):1111-1118.
5. Szczeklik A, Stevenson DD. Aspirin-induced asthma: advancesin pathogenesis, diagnosis, and management. J Allergy ClinImmunol. 2003;111(5):913-921.
6. Szczeklik A, Sanak M. The broken balance in aspirinhypersensitivity. Eur J Pharmacol. 2006;533(1-3):145-155.
7. Kowalski ML, Makowska J. Use of nonsteroidal anti-inflammatorydrugs in patients with aspirin hypersensitivity : safety of cyclo-oxygenase-2 inhibitors. Treat Respir Med. 2006;5(6):399-406.
8. Ring J, Messmer K. Incidence and severity of anaphylactoid reactionsto colloid volume substitutes. Lancet. 1977;309(8009):466-469.
9. Cakmak ME. Which non-steroidal anti-inflammatory drug(NSAID) is safer in patients with Non-steroids ExacerbatedRespiratory Disease (N-ERD)? A single-center retrospectivestudy. Tuberk Toraks. 2022;70(4):365-374.
10. Celik GE, Erkekol FO, Aydin O, Demirel YS, Misirligil Z. Aredrug provocation tests still necessary to test the safety of COX-2inhibitors in patients with cross-reactive NSAID hypersensitivity?Allergol Immunopathol. 2013;41(3):181-188.
11. Terzioglu K, Sancar O, Ekerbicer HC, Ozturk RT, Epozturk K.Tolerability to paracetamol and preferential COX-2 inhibitorsin patients with cross-reactive nonsteroidal anti-inflammatorydrugs hypersensitivity. Asia Pac Allergy. 2020;10(3):e29.
12. Gültuna S, Gümüşburun R, Bavbek S. Cross-reactivity betweenCOX-2 inhibitors in patients with cross-reactive hypersensitivityto NSAIDs. J Public Health Int. 2022;5(2):61-72.
13. Bavbek S, Dursun AB, Dursun E, Eryilmaz A, Misirligil Z. Safetyof meloxicam in aspirin-hypersensitive patients with asthmaand/or nasal polyps: a challenge-proven study. Int Arch AllergyImmunol. 2007;142(1):64-69.
14. Prieto A, De Barrio M, Martin E, et al. Tolerability to nabumetoneand meloxicam in patients with nonsteroidal anti-inflammatorydrug intolerance. J Allergy Clin Immunol. 2007;119(4):960-964.
15. Rojas-Mejia DV, Silva Espinosa DL, Martinez DM, RamirezZuluaga LF, Serrano Reyes CD. Meloxicam and/or etoricoxib couldbe administered safely in two equal doses during an open oralchallenge in patients with nonsteroidal anti-inflammatory drughypersensitivity. Int Arch Allergy Immunol. 2021;182(5):433-439.
16. Inomata N, Osuna H, Yamaguchi J, et al. Safety of selectivecyclooxygenase-2 inhibitors and a basic non-steroidal anti-inflammatory drug (NSAID) in Japanese patients with NSAID-induced urticaria and/or angioedema: comparison of meloxicam,etodolac and tiaramide. J Dermatol. 2007;34(3):172-177.
17. Quinones Estevez MD. Are selective COX-2 inhibitors a safe optionin patients with intolerance to nonsteroidal antiinflammatorydrugs? J Investig Allergol Clin Immunol. 2009;19(4):328-330.
18. Kowalski ML, Agache I, Bavbek S, et al. Diagnosis andmanagement of NSAID-Exacerbated Respiratory Disease(N-ERD)-a EAACI position paper. Allergy. 2019;74(1):28-39.
19. Pastorello EA, Zara C, Riario-Sforza GG, Pravettoni V, IncorvaiaC. Atopy and intolerance of antimicrobial drugs increase the risk ofreactions to acetaminophen and nimesulide in patients allergic tononsteroidal anti-inflammatory drugs. Allergy. 1998;53(9):880-884.
20. Tepetam FM, Çolakoğlu B, Ozer F, Maden E, Yosunkaya S,Duman D. Tolerabillity of nimesulide in patients with historiesof adverse reactions to acetylsalicylic acid and nonsteroidal anti-inflammatory drugs. Nobel Medicus. 2014;10(3):81-87.
21. Asero R. Risk factors for acetaminophen and nimesulideintolerance in patients with NSAID-induced skin disorders. AnnAllergy Asthma Immunol. 1999;82(6):554-558.
Article available in :
Volume 5, Issue 1, 2024
Page : 9-15
https://doi.org/10.47582/jompac.1414157
Article Information
Received : 04 Oca 2024
Accepted : 21 Oca 2024
Published : 29 Şub 2024
Corresponding Author :

Gözde Köycü Buhari: Atatürk Chest Disease and Chest Surgery Training and Research Hospital, Department of Allergy and Immunology, Ankara, Turkey

[email protected]
Citation : Köycü Buhari G, Koca Kalkan İ, Başa Akdoğan B, et al. Safety of partial selective COX-2 inhibitors in patients with cross-reactive NSAID hypersensitivity and factors affecting safety. J Med Palliat Care. 2024;5(1):9-15.

Read: 76
Cited: 0
Download : 109
_Footer