Use of Nonsteroidal Anti-Inflammatory Drugs in Patients with Aspirin Hypersensitivity
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Use of Nonsteroidal Anti-Inflammatory Drugs in Patients with Aspirin Hypersensitivity Safety of Cyclo-Oxygenase-2 Inhibitors Marek L. Kowalski and Joanna Makowska Department of Clinical Immunology and Allergy, Chair of Immunology, Faculty of Medicine, Medical University, Lodz, Poland
Abstract
This article provides information on the pathogenesis of aspirin hypersensitivity, cross-sensitivity, and cross-tolerance of different NSAIDs in patients with respiratory types of reactions. Hypersensitivity to aspirin may affect 5–20% of patients with chronic asthma and an unknown fraction of patients with chronic urticaria-angioedema. These patients develop cross-reactions to other, chemically non-related, NSAIDs with strong inhibitory activity towards cyclo-oxygenase (COX)-1 (e.g. indomethacin, naproxen, ketoprofen). Avoidance of aspirin and all cross-reacting NSAIDs as well as education of patients are crucial. As an alternative antipyretic or analgesic drug, aspirin-sensitive asthmatic patients may take acetaminophen (paracetamol) in low or moderate doses ( COX-2
Indomethacin Ibuprofen Sodium salicylate
15 2.8
COX-1 = COX-2
Naproxen
0.6
COX-1 < COX-2
Celecoxib Rofecoxib
0.03 0.003
COX-1
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