Vázquez-Cortés S, Vázquez-Fuertes L, Rodríguez-Alvarez M, Reig Rincón de Arellano I, Martínez-Cócera C
Servicio de Alergia, Hospital Clínico San Carlos, Madrid, Spain.
An Med Interna. 2008 Apr;25(4):163-7. doi: 10.4321/s0212-71992008000400003.
Hypersensitive reactions to analgesics in the general population are less than 1%. Previous studies have demonstrated that cyclooxigenase 2 (COX-2) inhibitors are an efficient alternative in patients with non-steroidal anti-inflammatory drugs (NSAIDs) intolerance. The aim of our study is to test the tolerance to celecoxib and meloxicam in patients with NSAIDs intolerance, upto dosages higher than those used in previous studies.
The subjects of the study were 38 NSAID-sensitive patients from September 2004 to June 2005. The diagnosis of intolerance to NSAIDs was carried out by means of single-blind placebo-controlled oral challenge with aspirin. We performed single-blind placebo controlled oral challenge tests with celecoxib (accumulated dose of 400 mg) and meloxicam (accumulated dose of 15 mg).
There was only one reaction with celecoxib (97.3%) which was generalised urticaria after the dose of 400 mg accumulated, it should be pointed out that this patient tolerated perfectly the dose of 200 mg. For meloxicam, we found 100% tolerance at a dosage of 15 mg, including the patient who showed a reaction to the celecoxib.
We consider that there are patients with tolerance to low dosages of COX-2 inhibitors who show a reaction on increasing the administered dosage, which means that their tolerance should be taken into account and checked in the long term.
普通人群中对镇痛药的过敏反应低于1%。先前的研究表明，环氧化酶2（COX-2）抑制剂是不耐受非甾体抗炎药（NSAIDs）患者的一种有效替代药物。我们研究的目的是测试NSAIDs不耐受患者对塞来昔布和美洛昔康的耐受性，直至高于先前研究中使用的剂量。
研究对象为2004年9月至2005年6月的38名对NSAIDs敏感的患者。通过对阿司匹林进行单盲安慰剂对照口服激发试验来诊断对NSAIDs的不耐受。我们对塞来昔布（累积剂量400mg）和美洛昔康（累积剂量15mg）进行了单盲安慰剂对照口服激发试验。
使用塞来昔布时，仅出现1例反应（97.3%），在累积剂量达到400mg后出现全身性荨麻疹，需要指出的是，该患者对200mg剂量耐受良好。对于美洛昔康，在15mg剂量时耐受性为100%，包括对塞来昔布有反应的患者。
我们认为，存在对低剂量COX-2抑制剂耐受但在增加给药剂量时出现反应的患者，这意味着应考虑并长期检查他们的耐受性。
