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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Use of Celecoxib in patients with nonsteroidal antiinflammatory drugs hypersensitivity

Abstract Number: T 46
Abstract Type: Case Report/Case Series

Genevieve Rivard MD, FRCPC1 ; Sandra Lesage MD, FRCPC2; Ema Ferreira B.Pharm., M.Sc., Pharm.D., FCSHP3; Chantal Crochetiere MD, FRCPC4

Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most widely used medications in the world[1], and their use for postoperative pain control after cesarean delivery has been part of a multimodal approach. Aspirin/NSAID sensitivity occurs in about 0,3% of the general population[1, 2]. It predominantly affects women, and its prevalence is increasing. Postpartum patients with contraindications to NSAIDs are left with fewer therapeutic options for pain management, and risk necessitating more opiates and therefore potentially more side effects. Given that suboptimal immediate post cesarean pain control may lead to a higher incidence of chronic pain[3], optimal postpartum pain management is essential.

Two main types of NSAID hypersensitivity reactions are usually seen: urticaria/angioedema reactions and NSAID-induced rhinitis and asthma (also known as aspirin/NSAID-induced respiratory reactions and aspirin triad). Usually, these reactions are pseudoallergies and are not IgE mediated. Rather they result from acquired alterations in the cyclooxygenase (COX) pathways which result from the mechanism of action of nonselective NSAIDs. A few publications have shown that COX-2 selective inhibitors could safely be used as an alternative in patients with NSAID hypersensitivity [4-6]. Vigilance, however, is advised since approximately 4% of patients with a history of urticaria/angioedema type reactions will also experience cutaneous reactions following a COX-2 selective inhibitor challenge. Patients with respiratory type sensitivity experience symptoms less frequently following Celecoxib challenge[1]. We will present a series of cases illustrating the management of patients with different aspirin/NSAID hypersensitivity reactions.

1. Knowles, S.R., et al., Management options for patients with aspirin and nonsteroidal antiinflammatory drug sensitivity. Ann Pharmacother, 2007. 41(7): p. 1191-200.

2. Jenkins, C., J. Costello, and L. Hodge, Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ, 2004. 328(7437): p. 434.

3. Miller, R.D., Miller’s Anesthesia. 7th ed, ed. C.L. Elsevier. Vol. 2. 2009, Philadelphia. 3084.

4. Dahlen, B., A. Szczeklik, and J.J. Murray, Celecoxib in patients with asthma and aspirin intolerance. The Celecoxib in Aspirin-Intolerant Asthma Study Group. N Engl J Med, 2001. 344(2): p. 142.

5. Sanchez-Borges, M., F. Caballero-Fonseca, and A. Capriles-Hulett, Safety of etoricoxib, a new cyclooxygenase 2 inhibitor, in patients with nonsteroidal anti-inflammatory drug-induced urticaria and angioedema. Ann Allergy Asthma Immunol, 2005. 95(2): p. 154-8.

6. Dona, I., et al., Response to a selective COX-2 inhibitor in patients with urticaria/angioedema induced by nonsteroidal anti-inflammatory drugs. Allergy, 2011. 66(11): p. 1428-33.

SOAP 2013