Authors: Kowalski, Marek L.; Makowska, Joanna

Source: Treatments in Respiratory Medicine, Volume 5, Number 6, 2006 , pp. 399-406(8)

Publisher: Adis International

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 (<1000mg). Preferential COX-2 inhibitors (nimesulide, meloxicam) are tolerated by the majority but not all hypersensitive patients. Selective COX-2 inhibitors (celecoxib and rofecoxib [withdrawn from the market]) are well tolerated by almost all aspirin-sensitive asthmatic patients. In patients with coronary artery disease requiring treatment with aspirin, desensitization to aspirin may be an alternative approach. Thus, for the majority of patients with asthma and hypersensitivity to aspirin or other NSAIDs, an alternative anti-inflammatory drug can be found. However, in each individual case physicians must consider the choice of an alternative NSAID carefully.

Keywords: Aspirin induced asthma; Aspirin induced asthma; Celecoxib; Meloxicam; Nimesulide; Nonsteroidal anti inflammatories; Nonsteroidal anti inflammatories; Paracetamol; Rofecoxib

Document Type: Leading article

Affiliations: 1: Department of Clinical Immunology and Allergy, Chair of Immunology, Faculty of Medicine, Medical University, Lodz, Poland

Publication date: 2006-01-01

Related content

• In this: publication
• By this: publisher
• In this Subject: Ear, Nose & Throat ,  Internal Medicine
• By this author: Kowalski, Marek L. ;  Makowska, Joanna

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers