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.
Ethical Statement
the study is approved by Keçiören Training and Research Hospital Ethics Committee Number: 2012-KAEK-15/2373 Date: 12.10.2021
References
- Torres MJ, Barrionuevo E, Kowalski M, Blanca M. Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs. Immunol Allergy Clin North Am. 2014;34(3):507-524.
- Kowalski ML, Asero R, Bavbek S, et al. Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy. 2013;68(10):1219-1232.
- Kowalski ML, Makowska JS, Blanca M, et al. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA(#) and GA2LEN/HANNA. Allergy. 2011;66(7):818-829.
- Nizankowska-Mogilnicka E, Bochenek G, Mastalerz L, et al. EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivity. Allergy. 2007;62(10):1111-1118.
- Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis, diagnosis, and management. J Allergy Clin Immunol. 2003;111(5):913-921.
- Szczeklik A, Sanak M. The broken balance in aspirin hypersensitivity. Eur J Pharmacol. 2006;533(1-3):145-155.
- Kowalski ML, Makowska J. Use of nonsteroidal anti-inflammatory drugs in patients with aspirin hypersensitivity : safety of cyclo-oxygenase-2 inhibitors. Treat Respir Med. 2006;5(6):399-406.
- Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;309(8009):466-469.
- Cakmak ME. Which non-steroidal anti-inflammatory drug (NSAID) is safer in patients with Non-steroids Exacerbated Respiratory Disease (N-ERD)? A single-center retrospective study. Tuberk Toraks. 2022;70(4):365-374.
- Celik GE, Erkekol FO, Aydin O, Demirel YS, Misirligil Z. Are drug provocation tests still necessary to test the safety of COX-2 inhibitors in patients with cross-reactive NSAID hypersensitivity? Allergol Immunopathol. 2013;41(3):181-188.
- Terzioglu K, Sancar O, Ekerbicer HC, Ozturk RT, Epozturk K. Tolerability to paracetamol and preferential COX-2 inhibitors in patients with cross-reactive nonsteroidal anti-inflammatory drugs hypersensitivity. Asia Pac Allergy. 2020;10(3):e29.
- Gültuna S, Gümüşburun R, Bavbek S. Cross-reactivity between COX-2 inhibitors in patients with cross-reactive hypersensitivity to NSAIDs. J Public Health Int. 2022;5(2):61-72.
- Bavbek S, Dursun AB, Dursun E, Eryilmaz A, Misirligil Z. Safety of meloxicam in aspirin-hypersensitive patients with asthma and/or nasal polyps: a challenge-proven study. Int Arch Allergy Immunol. 2007;142(1):64-69.
- Prieto A, De Barrio M, Martin E, et al. Tolerability to nabumetone and meloxicam in patients with nonsteroidal anti-inflammatory drug intolerance. J Allergy Clin Immunol. 2007;119(4):960-964.
- Rojas-Mejia DV, Silva Espinosa DL, Martinez DM, Ramirez Zuluaga LF, Serrano Reyes CD. Meloxicam and/or etoricoxib could be administered safely in two equal doses during an open oral challenge in patients with nonsteroidal anti-inflammatory drug hypersensitivity. Int Arch Allergy Immunol. 2021;182(5):433-439.
- Inomata N, Osuna H, Yamaguchi J, et al. Safety of selective cyclooxygenase-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.
- Quinones Estevez MD. Are selective COX-2 inhibitors a safe option in patients with intolerance to nonsteroidal antiinflammatory drugs? J Investig Allergol Clin Immunol. 2009;19(4):328-330.
- Kowalski ML, Agache I, Bavbek S, et al. Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)-a EAACI position paper. Allergy. 2019;74(1):28-39.
- Pastorello EA, Zara C, Riario-Sforza GG, Pravettoni V, Incorvaia C. Atopy and intolerance of antimicrobial drugs increase the risk of reactions to acetaminophen and nimesulide in patients allergic to nonsteroidal anti-inflammatory drugs. Allergy. 1998;53(9):880-884.
- Tepetam FM, Çolakoğlu B, Ozer F, Maden E, Yosunkaya S, Duman D. Tolerabillity of nimesulide in patients with histories of adverse reactions to acetylsalicylic acid and nonsteroidal anti-inflammatory drugs. Nobel Medicus. 2014;10(3):81-87.
- Asero R. Risk factors for acetaminophen and nimesulide intolerance in patients with NSAID-induced skin disorders. Ann Allergy Asthma Immunol. 1999;82(6):554-558.
Çapraz Reaktif NSAİİ Aşırı Duyarlılığı Olan Hastalarda Kısmi Selektif COX-2 inhibitörlerinin Güvenliği ve Etkileyen Faktörler
Abstract
AMAÇLAR
Nimesulid veya meloksikam gibi kısmi selektif COX-2 inhibitörleri, çapraz reaktif NSAİİ aşırı duyarlılığı olan hastaların çoğunluğu tarafından tolere edilir. Bu çalışmanın amacı, non-immünolojik tipte, çapraz reaktif NSAİİ aşırı duyarlılığında kısmi selektif COX-2 inhibitörleri nimesulid ve meloksikamın güvenliği hakkında daha fazla bilgi elde etmek ve bu ilaçlara karşı intolerans için risk faktörlerinin saptanmasıdır.
YÖNTEMLER
Çalışmamız 10 yıllık süre içerisinde kliniğimize başvuran, çapraz reaktif NSAİİ aşırı duyarlılığı olan hastaları kapsayan retrospektif bir çalışmadır. En az 2 farklı kimyasal sınıftan NSAİİ ile güvenilir tipte erken tipte aşırı duyarlılık hikaesi olan ve/veya ASA provokasyon testi pozitif olan ve kısmi selektif COX-2 inhibitörleri (nimesulid ve/veya meloksikam) ile alternatif ilaç provokasyon testi yapılan hastalar çalışmaya dahil edildi. Hastaların demografik bilgileri, eşlik eden hastalıkları, atopi durumları, NSAİİ aşırı duyarlılığının süresi, toplam reaksiyon sayısı, reaksiyon ağırlıkları, klinik fenotipleri, solunum fonksiyon testi parametreleri ve alternatif ilaç provokasyon testi sonuçları kaydedilir. Nimesulid ve/veya meloksikam ile yapılan alternatif provokasyon testlerinde reaksiyon görülen ve görülmeyen hastalar bu veriler açısından karşılaştırıldı.
BULGULAR
Çalışmaya 378'i (%67,5) kadın olmak üzere toplam 560 hasta dahil edildi. Hastaların 394'ünde (%72,6) alergoloji ilişkili komorbidite saptandı. Astım, diğer ilaç alerjileri ve nazal polip en sık eşlik eden hastalıklardı. Nimesulid ve/veya meloksikam ile alternatif ilaç provokasyon testi pozitifliği 560 hastanın 50'sinde (%8,9) tespit edildi. Provokasyon testi pozitifliği nimesulid ile 33/541 (%6,1), meloksikam ile 30/517 (%5,8) ve hem nimesulid hem de meloksikam ile 13/498 (%2,3) saptandı. Provokasyon testi pozitif olan hastalarda NSAİİ aşırı duyarlılığının süresi daha kısaydı ve alergoloji ilişkili komorbiditeler, astım, nazal polip ve astım ve nazal polipin birlikteliği daha sıktı.
SONUÇ
Kısmi selektif COX-2 inhibitörleri nimesulid ve meloksikam, çapraz reaktif NSAİİ aşırı duyarlılığı olan hastalarda iyi tolere edilen alternatiflerdir. Bu ilaçlara karşı aşırı duyarlılık, astım ve/veya nazal polip hastalarında, diğer çapraz reaktif NSAID aşırı duyarlılığı olan hasta grubuna göre ve aynı zamanda daha kısa süreli NSAID aşırı duyarlılığı olan hastalarda anlamlı derecede daha yüksektir.
References
- Torres MJ, Barrionuevo E, Kowalski M, Blanca M. Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs. Immunol Allergy Clin North Am. 2014;34(3):507-524.
- Kowalski ML, Asero R, Bavbek S, et al. Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy. 2013;68(10):1219-1232.
- Kowalski ML, Makowska JS, Blanca M, et al. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA(#) and GA2LEN/HANNA. Allergy. 2011;66(7):818-829.
- Nizankowska-Mogilnicka E, Bochenek G, Mastalerz L, et al. EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivity. Allergy. 2007;62(10):1111-1118.
- Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis, diagnosis, and management. J Allergy Clin Immunol. 2003;111(5):913-921.
- Szczeklik A, Sanak M. The broken balance in aspirin hypersensitivity. Eur J Pharmacol. 2006;533(1-3):145-155.
- Kowalski ML, Makowska J. Use of nonsteroidal anti-inflammatory drugs in patients with aspirin hypersensitivity : safety of cyclo-oxygenase-2 inhibitors. Treat Respir Med. 2006;5(6):399-406.
- Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;309(8009):466-469.
- Cakmak ME. Which non-steroidal anti-inflammatory drug (NSAID) is safer in patients with Non-steroids Exacerbated Respiratory Disease (N-ERD)? A single-center retrospective study. Tuberk Toraks. 2022;70(4):365-374.
- Celik GE, Erkekol FO, Aydin O, Demirel YS, Misirligil Z. Are drug provocation tests still necessary to test the safety of COX-2 inhibitors in patients with cross-reactive NSAID hypersensitivity? Allergol Immunopathol. 2013;41(3):181-188.
- Terzioglu K, Sancar O, Ekerbicer HC, Ozturk RT, Epozturk K. Tolerability to paracetamol and preferential COX-2 inhibitors in patients with cross-reactive nonsteroidal anti-inflammatory drugs hypersensitivity. Asia Pac Allergy. 2020;10(3):e29.
- Gültuna S, Gümüşburun R, Bavbek S. Cross-reactivity between COX-2 inhibitors in patients with cross-reactive hypersensitivity to NSAIDs. J Public Health Int. 2022;5(2):61-72.
- Bavbek S, Dursun AB, Dursun E, Eryilmaz A, Misirligil Z. Safety of meloxicam in aspirin-hypersensitive patients with asthma and/or nasal polyps: a challenge-proven study. Int Arch Allergy Immunol. 2007;142(1):64-69.
- Prieto A, De Barrio M, Martin E, et al. Tolerability to nabumetone and meloxicam in patients with nonsteroidal anti-inflammatory drug intolerance. J Allergy Clin Immunol. 2007;119(4):960-964.
- Rojas-Mejia DV, Silva Espinosa DL, Martinez DM, Ramirez Zuluaga LF, Serrano Reyes CD. Meloxicam and/or etoricoxib could be administered safely in two equal doses during an open oral challenge in patients with nonsteroidal anti-inflammatory drug hypersensitivity. Int Arch Allergy Immunol. 2021;182(5):433-439.
- Inomata N, Osuna H, Yamaguchi J, et al. Safety of selective cyclooxygenase-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.
- Quinones Estevez MD. Are selective COX-2 inhibitors a safe option in patients with intolerance to nonsteroidal antiinflammatory drugs? J Investig Allergol Clin Immunol. 2009;19(4):328-330.
- Kowalski ML, Agache I, Bavbek S, et al. Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)-a EAACI position paper. Allergy. 2019;74(1):28-39.
- Pastorello EA, Zara C, Riario-Sforza GG, Pravettoni V, Incorvaia C. Atopy and intolerance of antimicrobial drugs increase the risk of reactions to acetaminophen and nimesulide in patients allergic to nonsteroidal anti-inflammatory drugs. Allergy. 1998;53(9):880-884.
- Tepetam FM, Çolakoğlu B, Ozer F, Maden E, Yosunkaya S, Duman D. Tolerabillity of nimesulide in patients with histories of adverse reactions to acetylsalicylic acid and nonsteroidal anti-inflammatory drugs. Nobel Medicus. 2014;10(3):81-87.
- Asero R. Risk factors for acetaminophen and nimesulide intolerance in patients with NSAID-induced skin disorders. Ann Allergy Asthma Immunol. 1999;82(6):554-558.
Details
| Primary Language | English |
|---|---|
| Subjects | Allergy |
| Journal Section | Research Articles [en] Araştırma Makaleleri [tr] |
| Authors | |
| Publication Date | February 29, 2024 |
| Submission Date | January 4, 2024 |
| Acceptance Date | January 21, 2024 |
| Published in Issue | Year 2024 Volume: 5 Issue: 1 |
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TR DİZİN ULAKBİM and International Indexes (1d)
Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]
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