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Toleranz von Coxiben bei Intoleranz gegenuber nicht-steroidalen Antirheumatika (NSAR)

Published in Deutsche Medizinische Wochenschrift. 2005, vol. 130, no. 40, p. 2249-2252
Abstract BACKGROUND AND OBJECTIVE: Non-steroidal anti-inflammatory drugs (NSAIDs) frequently cause pseudoallergic reactions. Recognition of two different prostaglandin synthase iso-enzymes led to the development of the so-called coxibs preferentially inhibiting cyclooxygenase-2. We studied tolerability of valdecoxib preferentially inhibitng cyclooxygenase-2 in patients with a history of intolerance to NSAIDs. PATIENTS AND METHODS: 41 patients (30 female, 11male, age 14-74 years) with a history of intolerance to NSAIDs underwent scratch tests with these drugs and valdecoxib, followed by oral challenge with valdecoxib (maximum single dose: 20 mg; cumulative dose: 35mg) in a double-blind, placebo-controlled manner. RESULTS: The history of intolerance to NSAID comprised urticaria as the leading symptom (n = 26), followed by angioedema (n = 11) and anaphylactoid shock (n = 4). 21 patients reported reactions to only one NSAID, 15 identified 2 different triggering drugs, and 5 patients showed reactions to 3 different NSAIDs. Acetylsalicylic acid (n = 20) and diclofenac (n = 12) were the most frequent causative drugs. Upon oral challenge with valdecoxib, one patient developed generalized urticaria within 30 minutes following the last dose of valdecoxib; symptoms resolved after i. v. injection of 2 mg clemastine and 250 mg prednisolone. All other patients tolerated the oral challenge without adverse effects. CONCLUSION: Our results are in line with previous studies suggesting that preferential cyclooxygenase-2-inhibitors may safely be used by patients with known intolerance to NSAIDs.
Keywords Administration, OralAdolescentAdultAgedAnaphylaxis/chemically inducedAngioedema/chemically inducedAnti-Inflammatory Agents, Non-Steroidal/administration & dosage/*adverse effectsCyclooxygenase Inhibitors/administration & dosage/*adverse effectsDose-Response Relationship, DrugDouble-Blind Method*Drug HypersensitivityFemaleHumansIsoxazoles/administration & dosage/*adverse effectsMaleMiddle AgedSkin TestsSulfonamides/administration & dosage/*adverse effectsUrticaria/chemically induced
PMID: 16208597
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BOEHNCKE, Sandra, BOEHNCKE, Wolf-Henning. Toleranz von Coxiben bei Intoleranz gegenuber nicht-steroidalen Antirheumatika (NSAR). In: Deutsche Medizinische Wochenschrift, 2005, vol. 130, n° 40, p. 2249-2252. doi: 10.1055/s-2005-918556

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Deposited on : 2013-09-20

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