Parecoxib tolerability in patients with hypersensitivity to nonsteroidal anti-inflammatory drugs

Background: Adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly observed, particularly among patients with chronic urticaria or asthma. The identification of a safe and reliable alternative, especially when a parenteral therapy is required, is a frequent problem in clinical practice. Objective: To investigate the clinical tolerability of parecoxib, the only selective COX-2 inhibitor that can be used for parenteral administration, in a group of patients with a well-established NSAID hypersensitivity. Methods: We assessed 27 adults (19 women and 8 men) who reported one or more adverse reactions to NSAIDs, manifested as cutaneous, respiratory, or anaphylactic symptoms. Sixteen of them reported reactions to a single NSAID (single reactors) and 11 to more than one (multiple reactors); the most frequently involved drug was ASA. Each patient first underwent allergologic tests (skin tests, patch tests, and/or oral challenge tests) with culprit NSAIDs and then tolerability tests with increasing intravenous doses of parecoxib up to 40 mg. All challenges were performed under single-blind, placebo-controlled conditions. Results: NSAID hypersensitivity was diagnosed in all 27 patients: 2 displayed positive results to skin tests, 1 to patch tests, and the other 24 to challenges. None reacted to either placebos or parecoxib. Conclusions: Parecoxib seems to be a safe alternative for patients with well-demonstrated NSAID hypersensitivity requiring parenteral administration.