Cross-reactivity to Acetaminophen and Celecoxib According to the Type of Nonsteroidal Anti-inflammatory Drug Hypersensitivity.
10.4168/aair.2014.6.2.156
- Author:
Yoon Jeong KIM
1
;
Kyung Hwan LIM
;
Mi Young KIM
;
Eun Jung JO
;
Suh Young LEE
;
Seung Eun LEE
;
Min Suk YANG
;
Woo Jung SONG
;
Hye Ryun KANG
;
Heung Woo PARK
;
Yoon Seok CHANG
;
Sang Heon CHO
;
Kyung Up MIN
;
Sae Hoon KIM
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. shkrins@gmail.com
- Publication Type:Original Article
- Keywords:
Acetaminophen;
celecoxib;
cross reactions;
hypersensitivity;
intolerance;
anti-inflammatory agents;
non-steroidal
- MeSH:
Acetaminophen*;
Analgesics;
Anti-Inflammatory Agents;
Anti-Inflammatory Agents, Non-Steroidal;
Aspirin;
Classification;
Cross Reactions;
Drug Hypersensitivity*;
Humans;
Hypersensitivity;
Medical Records;
Methods;
Retrospective Studies;
Risk Factors;
Urticaria;
Celecoxib
- From:Allergy, Asthma & Immunology Research
2014;6(2):156-162
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Identification of tolerable alternative analgesics is crucial for management in nonsteroidal anti-inflammatory drug (NSAID)-sensitive patients. We investigated cross-reactivity of acetaminophen and celecoxib according to the type of aspirin/NSAID hypersensitivity and aimed to determine the risk factors for cross-intolerance. METHODS: We retrospectively reviewed the medical records of patients intolerant to aspirin and NSAIDs who had undergone an acetaminophen and/or celecoxib oral provocation test. Aspirin/NSAID hypersensitivity was classified into 4 types according to a recently proposed classification: aspirin-exacerbated respiratory disease (AERD), aspirin-exacerbated chronic urticaria (AECU), aspirin-induced acute urticaria/angioedema (AIAU), and NSAID-induced blended reaction (NIRD). RESULTS: A total of 180 patients with hypersensitivity to aspirin and NSAIDs were enrolled; 149 acetaminophen provocation test results and 145 celecoxib provocation test results were analyzed. The overall cross-reaction rates to acetaminophen and celecoxib were 24.8% and 10.3%, respectively. There was a significant difference in the cross-reactivity to acetaminophen according to the type of NSAID hypersensitivity. Cross-reactivity to acetaminophen was highest in the AECU group (43.9%), followed by the AERD (33.3%), NIBR (16.7%), and AIAU (12.5%) groups. Underlying chronic urticaria was more prevalent in patients with cross-intolerance to both acetaminophen (P=0.001) and celecoxib (P=0.033). Intolerance to acetaminophen was associated with intolerance to celecoxib (P<0.001). CONCLUSIONS: Acetaminophen and celecoxib may induce adverse reactions in a non-negligible portion of aspirin/NSAID-sensitive patients. Physicians should be aware of the possible cross-reactions of these alternative drugs and consider an oral challenge test to confirm their tolerability.
