The wider usage of non
steroid antiinflammatory drugs (
NSAIDs) raises the significance of their side effects. The discovery of the two different cyclo-
oxygenases (COX 1 and COX-2) led to the incorporation of more selective
enzyme inhibitors into the therapeutic tools against disorders with
pain and
inflammation, in order to minimize the frequency of the side effects. Selective
COX-2 inhibitors are well tolerated by most of the patients with a history of sensitivity against classical
NSAIDs. The well-known gastrointestinal side effects (
ulcers, bleedings) are much less frequent in the case of selective
COX-2 inhibitors in comparison with non-selective COX inhibitors. However, the lack of "healing"
prostaglandins as an effect of COX-2 antagonism may prevent the improvement of existing
ulcers. In addition almost all other organs have been found to be affected in COX-2 knockout mice (COX-2 paradoxon). Hepatotoxicity is usually rare, its reason is most probably idiosyncrasy. Persistent nephropathy can be worsened by the inhibition of COX-2, however normal renal functions have not been changed in humans using selective
COX-2 inhibitors. Authors' registry consists of 1000 patients with a history of suspected
drug-allergy, during a 15 years' period. Approximately 30% of the cases have been connected with
NSAIDs and with
antirheumatic drugs. Because of functional similarities
gold salts, proved suitable for the treatment of
juvenile rheumatoid arthritis (JRA) and of
osteoarthritis (OA) were included as well. Besides rheumatologic applications the second most common indication for these drugs was
pain and/or
fever. Among cutaneous symptoms intolerance was present at a relatively low frequency--as
salicylates had not been taken into consideration. Next to
salicylates the most frequent side effects were caused by pyrazolon derivates.
Urticaria and
angioedema were the most frequently observed symptoms on the skin--our observations are in accordance with other publications.
CONCLUSIONS: