The identification of a safe and reliable alternative for patients with non-steroidal anti-inflammatory
drug (
NSAID)-induced
urticaria/
angioedema is a frequent problem for dermatologists and other practitioners.
Cyclooxygenase-2 (COX-2) inhibitors have been reported to be safe for
NSAID-intolerant patients from the US and Europe but not all of them have yet been approved for use in Japan. It was our objective to investigate the clinical manifestations of oral
NSAID challenges in Japanese patients with histories of
urticaria and/or
angioedema after the intake of
NSAIDs and to find safe alternative drugs, including
COX-2 inhibitors and a basic anti-inflammatory
drug. Twenty subjects suspected
NSAID-induced
urticaria/
angioedema from histories were included in a double-blind or single-blind, placebo-controlled oral challenge protocol using
NSAIDs. Skin prick tests using
NSAIDs, which were dissolved in saline, were conducted. The mean age of the patients was 37.3 years; 14 patients were female. The results of other challenge tests showed that the most frequently intolerated drugs was
loxoprofen (100%), followed by acetyl salicylic (94.4%),
etodolac (53.3%),
dicrofenac (50%),
acetaminophen (38.5%),
meloxicam (33%), and
tiaramide (21.4%).
Urticaria and
angioedema were induced after
aspirin intake in 83.3% and 22.2% of patients, respectively, whereas an asthmatic response was seen in 5.6%. Skin prick tests with
NSAIDs were 100% negative. This study showed that among the
NSAIDs that are available in Japan and that were investigated in this study,
tiaramide, which does not inhibit COX, is the relatively safe alternative
drug for Japanese patients with
NSAID-induced urtiacaria and/or
angioedema. Furthermore,
meloxicam seems to be better tolerated than
etodolac between two selective
COX-2 inhibitors.