Parecoxib tolerability in patients with hypersensitivity to nonsteroidal anti-inflammatory drugs. effects/*immunology

摘要

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetylsalicylic acid (ASA) and pyrazolone derivatives, are among the most frequent causes of adverse drug reactions, particularly among patients with chronic urticaria or asthma. Many subjects report cutaneous (urticaria and/or angioedema), respiratory (rhinitis and/or asthma), or ana-phylactic symptoms after the intake of 1 or more drags of this class. In some patients, NSAIDs, particularly pyrazo-lones, can elicit allergic hypersensitivity reactions,2'3 but in the vast majority of cases NSAID hypersensitivity is mediated by the inhibition of COX-1 (the constitutive isoform), which, through depletion of the protective prostaglandin E_2, promotes the unrestrained synthesis of cysteinyl leukotrienes and release of mediators such as prostaglandin D_2 from mast cells. For this reason, selective NSAIDs, which inhibit mainly the induced isoform of COX (COX-2) without affecting the arachidonic acid metabolism, can be considered good alternatives for patients with hypersensitivity to nonselective NSAIDs (which inhibit both COX-1 and COX-2).