Etoricoxib tolerability in patients with hypersensitivity to nonsteroidal anti-inflammatory drugs.
ABSTRACT 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 is a frequent problem in clinical practice. Our aim was to investigate the clinical tolerability of etoricoxib, a new selective cyclooxygenase-2 inhibitor, in a group of patients with well-established NSAID hypersensitivity.
We assessed 31 adults (21 women and 10 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 15 to more than one NSAID (multiple reactors); the most frequently involved drug was acetylsalicylic acid. First, each patient underwent allergologic tests (skin and/or oral challenge tests) with culprit NSAIDs and then tolerability tests with increasing doses of etoricoxib up to 120 mg. All challenges were performed under single-blind, placebo-controlled conditions.
NSAID hypersensitivity was diagnosed in all 31 patients: 3 displayed positive results to pyrazolone skin tests and the other 28 to challenges with culprit NSAIDs. None reacted to either placebos or etoricoxib.
Etoricoxib seems to be a safe alternative for patients with well-demonstrated NSAID hypersensitivity.
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ABSTRACT: Mastocytosis encompasses a group of rare clinical entities, which are characterized by an abnormal growth and, usually, low accumulation of clonal and morphologically abnormal mast cells (MCs), within one or more organs. Clinical presentations are quite variable and symptoms are usually related to the release of mast cell mediators, tissue infiltration by MC (usually in the aggressive categories of the disease), or both. Mast cells are hematopoietic-derived cells that reach phenotypic maturity in the mucosa and peripheral connective tissues. These cells play an active role both on immunologic and non-immunologic processes. Within the oral cavity, MCs reside in the connective tissues, in physiologic conditions, and their number is elevated in pathologic situations resulting from immunoinflammatory processes, such as pulpal inflammation and periodontal disease. As MCs influence so many phenomena within the oral cavity, mastocytosis may manifest itself in the oral tissues. Patients with mastocytosis should be put under special care by dental professionals, in what concerns not only general patient management, but also drug prescription, as they are particularly prone to anaphylaxis and other peri and post-operative complications. Several allergens or mast cell activation triggers such as local anesthetics, zinc oxide, eugenol, penicilins, metals and oral hygiene products are frequently administered or prescribed by dentists. Patients with mastocytosis may also require stress management, during dental consultation. This review aims to briefly summarize the potential ways in which mast cell disease may affect the oral cavity and the dental management of mastocytosis affected patients.Journal of Oral Pathology and Medicine 12/2010; 40(6):441-50. · 1.63 Impact Factor
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ABSTRACT: Non-steroidal anti-inflammatory drugs (NSAIDs) are a frequent cause of hypersensitivity reactions, therefore, in clinical practice, it's important to find safe and effective substances. To evaluate the tolerability of etoricoxib and its subsequent actual use and safety at home. Etoricoxib tolerance was assessed by single-blind-placebo-controlled oral challenges and its subsequent use was checked by a standardized telephone call. The test was performed in 139 subjects (83 single NSAID reactors and 56 multiple NSAID reactors). The drug was not tolerated in 4 cases (2.8%) causing wheals on the face area in 3 single reactors and a severe generalised reaction occurring three hours after the intake of a therapeutic dose in a multiple reactor. The phone calls showed that 64 (52.8%) patients did not take etoricoxib, mostly due to the fear of adverse effects; in 5 cases (4.2%), the practitioner prescribed a different NSAIDs. Only 52 (43%) subjects took etoricoxib after oral challenges; all tolerated the drug but 2 single reactors, who reported a very mild labial oedema. Our study confirmed the good long-term tolerability of etoricoxib in patients with a history of hypersensitivity to other NSAIDs without differences between single and multiple reactors. Nonetheless, in NSAID-intolerant subjects this drug should be first challenged in specialised centres due to the risk ofsevere reactions.European annals of allergy and clinical immunology 12/2010; 42(6):216-20.