Senna G, Bilò M B, Antonicelli L, Schiappoli M, Crivellaro M A, Bonadonna P, Dama A R
Unità Operativa di Allergologia, Ospedale Civile Maggiore di Verona, Verona, Italy.
Eur Ann Allergy Clin Immunol. 2004 Jun;36(6):215-8.
Patients with aspirin-sensitive respiratory and cutaneous diseases experience cross reactions to all nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclo-oxigenase (COX) enzymes. As are now available drugs which selectively inhibit COX-2, questions are raised whether cross-reactivity occurs between aspirin and these COX 2 inhibitors.
The aim of this study was to evaluate the tolerability of three COX-2 inhibitors (meloxicam, celecoxib and rofecoxib) in subjects with previous pseudoallergic respiratory and cutaneous reactions to NSAIDs.
76 subjects with documented previous cutaneous and respiratory pseudoallergic reactions to aspirin and/or other NSAIDs underwent a single blind challenge with celecoxib, meloxicam and rofecoxib.
All subjects with previous respiratory reactions tolerated all drugs. Three subjects with multiple-drug induced urticaria complained of a generalized reaction after challenge (Two due to celecoxib and one due to meloxicam). Among the group of patients with NSAIDs-induced urticaria five complained of a relapse of the disease due to rofecoxib (one subject), celecoxib (two subjects and meloxicam (two subjects).
According to these results the cross-reactivity between aspirin and these COX-2 inhibitors does not occur in subjects with previous respiratory pseudoallergic reactions. A good safety profile was also demonstrated in patients with cutaneous reactions, being few reactions observed. However for this reason a controlled oral challenge with these drugs is useful for the proper management of patients sensitive to classic NSAIDs.
对阿司匹林敏感的呼吸道和皮肤疾病患者会对所有抑制环氧化酶（COX）的非甾体抗炎药（NSAIDs）产生交叉反应。由于现在有选择性抑制COX-2的药物，因此有人提出阿司匹林与这些COX-2抑制剂之间是否会发生交叉反应的问题。
本研究的目的是评估三种COX-2抑制剂（美洛昔康、塞来昔布和罗非昔布）在既往对NSAIDs有假性过敏呼吸道和皮肤反应的受试者中的耐受性。
76名既往有记录的对阿司匹林和/或其他NSAIDs有皮肤和呼吸道假性过敏反应的受试者接受了塞来昔布、美洛昔康和罗非昔布的单盲激发试验。
所有既往有呼吸道反应的受试者对所有药物均耐受。三名有多药诱发荨麻疹的受试者在激发试验后出现全身反应（两名因塞来昔布，一名因美洛昔康）。在NSAIDs诱发荨麻疹的患者组中，五名患者抱怨因罗非昔布（一名受试者）、塞来昔布（两名受试者）和美洛昔康（两名受试者）导致疾病复发。
根据这些结果，阿司匹林与这些COX-2抑制剂之间在既往有呼吸道假性过敏反应的受试者中不会发生交叉反应。在有皮肤反应的患者中也显示出良好的安全性，观察到的反应很少。然而，由于这个原因，对这些药物进行口服激发试验有助于对经典NSAIDs敏感的患者的合理管理。
