Confino-Cohen Ronit, Goldberg Arnon
Allergy and Clinical Immunology Unit, Meir General Hospital, 44281 Kfar Saba, Israel.
Allergy Asthma Proc. 2003 Jul-Aug;24(4):281-4.
Aspirin and all nonsteroidal anti-inflammatory drugs (NSAIDs) are a chemically heterogeneous group of compounds that share the ability to inhibit the enzyme cyclooxygenase (COX). This inhibitory effect, especially of COX-1, is suggested as the mechanism underlying NSAID-induced hypersensitivity reactions. In this study, we evaluated the safety and convenience of a single full-dose challenge with nabumetone, a selective COX-2 inhibitor, in patients with hypersensitivity to nonselective NSAIDs (ns-NSAIDs). Twenty-four subjects with a history of hypersensitivity reactions to at least two different ns-NSAIDs on two different occasions were enrolled in the study. The patients were otherwise healthy and did not suffer from NSAID- or aspirin-induced asthma or urticaria. All subjects were orally challenged by a single full dose (1000 mg) of nabumetone, monitored closely in the hospital for the next 4 hours and contacted by telephone the next morning and 3-12 months afterward. Twenty-two patients tolerated nabumetone without any reaction during and after the challenge. One patient had a single urticarial lesion and one patient reported mild pruritus without objective signs, both of which resolved spontaneously. Thirteen patients, including the patient who responded with pruritus to the challenge, used nabumetone on several occasions during the follow-up period without any adverse reaction. Our study shows that in patients with a history of aspirin- and ns-NSAID-induced hypersensitivity reaction, a rapid one-step challenge with nabumetone was well tolerated. These initial data support the possibility that a single full dose of nabumetone can be tried as a safe alternative in most patients with a hypersensitivity reaction to ns-NSAIDs.
阿司匹林和所有非甾体抗炎药（NSAIDs）是一组化学性质各异的化合物，它们都具有抑制环氧化酶（COX）的能力。这种抑制作用，尤其是对COX-1的抑制作用，被认为是非甾体抗炎药引起超敏反应的潜在机制。在本研究中，我们评估了对非选择性NSAIDs（ns-NSAIDs）过敏的患者单次全剂量服用选择性COX-2抑制剂萘丁美酮的安全性和便利性。24名在不同场合对至少两种不同的ns-NSAIDs有过敏反应史的受试者被纳入研究。这些患者在其他方面健康，没有患NSAID或阿司匹林诱发的哮喘或荨麻疹。所有受试者口服单次全剂量（1000毫克）的萘丁美酮，在接下来的4小时内在医院密切监测，并在第二天上午以及3至12个月后通过电话联系。22名患者在服药期间及之后耐受萘丁美酮，没有任何反应。一名患者出现单个荨麻疹皮损，一名患者报告有轻度瘙痒但无客观体征，两者均自发消退。13名患者，包括对服药有瘙痒反应的患者，在随访期间多次使用萘丁美酮，没有任何不良反应。我们的研究表明，有阿司匹林和ns-NSAIDs诱发超敏反应史的患者，对萘丁美酮进行快速一步激发试验耐受性良好。这些初步数据支持了这样一种可能性，即在大多数对ns-NSAIDs过敏反应的患者中，可以尝试单次全剂量的萘丁美酮作为一种安全的替代方法。
