[Tolerance to celecoxib and meloxicam in patients with intolerance to nonsteroidal anti-inflammatory drugs]. / Tolerancia a celecoxib y meloxicam en pacientes con intolerancia a analgésicos no esteroideos.

INTRODUCTION: 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. MATERIAL AND METHODS: 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). RESULTS: 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. CONCLUSION: 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.

Tolerancia a celecoxib y meloxicam en pacientes con intolerancia a analgésicos no esteroideos / Tolerance to celecoxib and meloxicam in patients with intolerance to nonsteroidal anti-inflammatory drugs

Introducción: Las reacciones de hipersensibilidad a analgésicos en la población general son menores del 1%. En estudios previos se ha comprobado que los inhibidores de la ciclo-oxigenasa 2 (COX-2) son una alternativa eficaz en pacientes con intolerancia a antiinflamatorios no esteroideos (AINES). El objetivo de nuestro estudio es comprobar la tolerancia en pacientes diagnosticados de intolerancia a AINES a celecoxib y meloxicam, hasta dosis superiores a las utilizadas en estudios previos. Material y métodos: Los sujetos del estudio son 38 pacientes diagnosticados en nuestro Servicio de Alergia del Hospital Clínico San Carlos de intolerancia a AINES desde el mes de septiembre de 2004 a junio de 2005. El diagnóstico de intolerancia a AINES se había realizado mediante POSCCP (provocación oral simple ciego controlada con placebo) con AAS según protocolo de nuestro servicio. Se llevaron a cabo POSCCP con celecoxib hasta una dosis acumulada de 400 mg y meloxicam hasta una dosis acumulada de 15 mg. Resultados: Sólo se presentó una reacción con celecoxib que consistió en urticaria generalizada tras la toma de 400 mg acumulados. Este paciente había tolerado previamente una dosis de 200 mg. Con respecto al meloxicam, encontramos una tolerancia del 100%, incluyendo el paciente que presentó reacción con celecoxib. Conclusiones: Consideramos que al existir pacientes con tolerancia a dosis bajas de los inhibidores de la COX-2 que presentan reacción al elevar la dosis administrada, se debería comprobar la tolerancia de estos fármacos a largo plazo

Introduction: 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 andmeloxicam in patients with NSAIDs intolerance, upto dosages higherthan those used in previous studies. Material and methods: 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). Results: 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. Conclusion: 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

Inducción de tolerancia en la hipersensibilidad a mesalazina (5-ASA) / Inductionof tolerance in hypersensitivity to mesalazine (5-ASA)

La mesalazina es un derivado del ácido 5-aminosalicílico (5-ASA, el cual es útil en el tratamiento de la enfermedad inflamatoria intestinal. La sulfasalazina está formada por dos partes, la sulfapiridina y el 5-ASA, siendo ésta última la parte activa de la molécula. Los nuevos preparados derivados del 5-ASA se desarrollaron tratando de evitar los efectos secundarios tradicionalmente asociados a la sulfapiridina, aunque se siguen observando y aparecen nuevos efectos. Presentamos dos casos, el primero es un varón diagnosticado de enfermedad inflamatoria intestinal, con antecedentes de dos reacciones previas de urticaria y angioedema tras ácido acetilsalicílico, que presenta urticaria tras la toma de mesalazina. El segundo presenta urticaria generalizada tras tres meses de iniciar tratamiento con mesalazina. Dada la necesidad de tratamiento en ambos casos, se realiza el protocolo de desensibilización a mesalazina desarrollado en 17 días en nuestro servicio, con el que se llega a la tolerancia de dicho fármaco hasta dosis terapéuticas. Ante pacientes con hipersensibilidad a distintos fármacos, que sean necesarios para el tratamiento de su patología, pueden realizarse pautas de “desensibilización”, que aseguren una buena tolerancia

Mesalazine is a derivative of 5-aminosalicylic acid (5-ASA), which is useful in the treatment of intestinal inflammatory disease. Sulfasalazine is formed by two parts, sulfapyridine and 5-ASA, the latter being the active part of the molecule. The new preparatives derived from 5-ASA were developed in an attempt to avoid the traditionally associated side effects to sulfapyridine, although they are still observed and new effects appear. We present two cases. The first is a man diagnosed of inflammatory intestinal disease, with background of two previous reactions of urticaria and angioedema after acetyl salicylic acid, who presented urticaria after taking mesalazine. The second one had generalized urticaria after three months of initiating treatment with mesalazine. Given the need for treatment in both cases, a desensitization protocol to mesalazine was made. It was developed in 17 days in our service. Tolerance to that drug to therapeutic doses is reached. When faced with patients with hypersensitivity to different drugs, that are necessary to treat their disease, “desensitization” regimes, that assure good tolerance, can be made

[Induction of tolerance in hypersensitivity to mesalazine (5-ASA)]. / Inducción de tolerancia en la hipersensibilidad a mesalazina (5-ASA).

Mesalazine is a derivative of 5-aminosalicylic acid (5-ASA), which is useful in the treatment of intestinal inflammatory disease. Sulfasalazine is formed by two parts, sulfapyridine and 5-ASA, the latter being the active part of the molecule. The new preparatives derived from 5-ASA were developed in an attempt to avoid the traditionally associated side effects to sulfapyridine, although they are still observed and new effects appear. We present two cases. The first is a man diagnosed of inflammatory intestinal disease, with background of two previous reactions of urticaria and angioedema after acetyl salicylic acid, who presented urticaria after taking mesalazine. The second one had generalized urticaria after three months of initiating treatment with mesalazine. Given the need for treatment in both cases, a desensitization protocol to mesalazine was made. It was developed in 17 days in our service. Tolerance to that drug to therapeutic doses is reached. When faced with patients with hypersensitivity to different drugs, that are necessary to treat their disease, "desensitization" regimes, that assure good tolerance, can be made.