Senna Gian Enrico, Passalacqua Giovanni, Dama Annarita, Crivellaro Mariangiola, Schiappoli Michele, Bonadonna Patrizia, Canonica Giorgio Walter
Allergy Service, Verona General Hospital, Verona, Italy.
Eur Ann Allergy Clin Immunol. 2003 Dec;35(10):393-6.
Pseudoallergic reactions to ASA and NSAIDs in general are frequent and difficult to manage. The challenge with the suspected drug is considered unethical, therefore the only possible approach is a challenge with alternative drugs. Selective COX2 inhibitors are considered the most suitable alternative drugs. We describe the comparative results and follow-up of an oral challenge with nimesulide and meloxicam, in NSAIDs intolerant patients.
381 patients (118 male, 263 female, mean age 53.2 years) with a well documented pseudoallergic reaction to NSAIDs underwent an oral challenge with these alternative drugs. All 381 patients were given nimesulide 88 of them were also given meloxicam. All patients were re-interviewed at six-month intervals up to two years after challenge.
98.4% of the patients tolerated nimesulide and 95.4% tolerated meloxicam. The reactions occurred during challenges were mild and easily manageable. Three out of the six nimesulide-intolerant patients could tolerate meloxicam, whereas only one of the four meloxicam-intolerant patients could tolerate nimesulide. At the follow-up, 96% of patients with previous negative challenge could tolerate nimesulide and within the patients which took meloxicam after challenge no pseudoallergic reaction occurred.
The herein described challenge with alternative drugs, meloxicam and nimesulide, is a safe tool for the management of NSAIDs-intolerant patients. The two tested drug are safe and reliable alternatives for these patients.
一般来说，对阿司匹林和非甾体抗炎药的伪过敏反应很常见且难以处理。对可疑药物进行激发试验被认为是不道德的，因此唯一可行的方法是用替代药物进行激发试验。选择性环氧化酶 -2 抑制剂被认为是最合适的替代药物。我们描述了在非甾体抗炎药不耐受患者中用尼美舒利和美洛昔康进行口服激发试验的比较结果及随访情况。
381 例（118 例男性，263 例女性，平均年龄 53.2 岁）有明确记录的对非甾体抗炎药伪过敏反应的患者接受了这些替代药物的口服激发试验。381 例患者均服用了尼美舒利，其中 88 例还服用了美洛昔康。所有患者在激发试验后每六个月重新接受访谈，直至两年。
98.4%的患者耐受尼美舒利，95.4%的患者耐受美洛昔康。激发试验期间发生的反应轻微且易于处理。6 例不耐受尼美舒利的患者中有 3 例可耐受美洛昔康，而 4 例不耐受美洛昔康的患者中只有 1 例可耐受尼美舒利。随访时，之前激发试验结果为阴性的患者中有 96%可耐受尼美舒利，激发试验后服用美洛昔康的患者中未发生伪过敏反应。
本文所述的用美洛昔康和尼美舒利等替代药物进行激发试验，是管理非甾体抗炎药不耐受患者的一种安全工具。这两种受试药物对这些患者来说是安全可靠的替代品。
