Abstract | UNLABELLED: Summary Background In the clinical practice patients with a history of acute urticaria induced by a single non-steroidal anti-inflammatory drug ( NSAID) and seeking for safe alternative drugs generally undergo tolerance tests with alternative NSAIDs that have little or no cyclooxygenase-1 (COX-1) enzyme inhibitory activity. This practice does not allow for the detection of single NSAID reactors and may lead to unnecessary avoidance of many potentially useful NSAIDs. OBJECTIVE: Evaluate aspirin challenge as a means to distinguish single from multiple NSAID intolerance in patients with a clinical history of acute urticaria induced by a single NSAID. Methods One hundred and seventeen otherwise normal subjects with a history of acute urticaria following the ingestion of a single NSAID ( pyrazolones (n=58), nimesulide (n=17), propionic acid derivatives (n=13), aryl acetic acid derivatives (n=14), acetaminophen (n=9), piroxicam (n=5), and indometacin (n=1)) underwent single-blind placebo-controlled oral challenges with aspirin. Aspirin-intolerant subjects underwent further tolerance tests drugs exerting little or no inhibitory activity on COX-1 enzyme (including paracetamol, nimesulide, rofecoxib, tramadol, and floctafenine). Results Aspirin induced urticaria in 28/117 (24%) patients. Five out of 28 (18%) aspirin reactors did not tolerate alternative NSAID on subsequent oral challenges. Conclusion In subjects with a history of urticaria induced by a single NSAID (other than aspirin) the diagnostic workup should start with an aspirin challenge in order to detect single/multiple NSAID reactors.
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Authors | R Asero |
Journal | Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology
(Clin Exp Allergy)
Vol. 35
Issue 6
Pg. 713-6
(Jun 2005)
ISSN: 0954-7894 [Print] England |
PMID | 15969659
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
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Chemical References |
- Analgesics
- Anti-Inflammatory Agents, Non-Steroidal
- Cyclooxygenase Inhibitors
- Lactones
- Sulfonamides
- Sulfones
- ortho-Aminobenzoates
- rofecoxib
- Acetaminophen
- Tramadol
- floctafenine
- Aspirin
- nimesulide
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Topics |
- Acetaminophen
(administration & dosage, adverse effects)
- Acute Disease
- Administration, Oral
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Analgesics
(administration & dosage, adverse effects)
- Anti-Inflammatory Agents, Non-Steroidal
(administration & dosage, adverse effects)
- Aspirin
(administration & dosage, adverse effects)
- Child
- Cyclooxygenase Inhibitors
(administration & dosage, adverse effects)
- Drug Evaluation
- Female
- Humans
- Lactones
(administration & dosage, adverse effects)
- Male
- Middle Aged
- Recurrence
- Single-Blind Method
- Sulfonamides
(administration & dosage, adverse effects)
- Sulfones
(administration & dosage, adverse effects)
- Tramadol
(administration & dosage, adverse effects)
- Urticaria
(chemically induced, immunology)
- ortho-Aminobenzoates
(administration & dosage, adverse effects)
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