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Tolerance of rofecoxib in patients with adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs)
S140
Abstracts
Identification of T-Cell Epitopes of Cry j 1 in Dogs Sensitive to 4N~PJF'7 Japanese Cedar (Cryptomeria Japonica) Pollen Kenichi Masuda*, Masahiro Sakaguchi§, Saburo Saito~, Douglus J DeboerC, Keigo Kurata*, Sadatoshi Maeda*, Toshihiro Tsukui<,, Shigehiro lwabuchi~, Koichi Ohno*, Hajime Tsujimoto* *University of Tokyo, Bunkyo-ku, Tokyo, Japan §National Institute of Infectious Diseases, Tokyo, Japan ¥Jikei University, Tokyo, Japan ~University of Wisconsin, Madison, WI <
408
IgE Reactivity and Cross-Reactivity to Japanese Cedar (Cryptomeria Japonica) and Cypress (Chamaecyparis Obtusa) Pollen Allergens in Dogs With Atopic Dermatitis
Masahiro Sakaguchi*, Kenichi Masuda§, Hiroshi Yasueda¥, Saburo SaitoC, Douglus J Deboer~<, Hajime Tsujimoto§ *National Institute of Infectious Diseases, Tokyo, Japan §University of Tokyo, Tokyo, Japan ~qational Sagamihara Hospital, Sagamihara, Japan ~Jikei University, Tokyo, Japan <
J ALLERGY CLIN IMMUNOL JANUARY 2002
observed by the ELISA inhibition method, and Cry j 1 showed a greater inhibition than Cha o 1. We found the same findings in human patients with CJ pollinosis. In Tokyo area during the spring season, the level of airborne CJ pollen is several times that of airborne CO pollen. From these findings, sensitization to CJ pollen allergen might be predominant in humans and dogs.
f ~ O T h e Safety of Rofecoxib in Patients With NSAID-Induced Urticaria and Angioedema
4 V~F
Khai Pang Leong, Chwee Ying Tang, Bernard Thong, Hiok Hee Chng Tan Tock Seng Hospital, Singapore, Singapore BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are among the commonest drugs prescribed in the world. However, they are associated with many adverse effects, including peptic ulceration and renal impairment. Many patients are intolerant of NSAIDs and they develop asthma or urticaria/angioedema within an hour of drug exposure. Cyclooxygenase (COX) inhibition is probably the common mechanism both for NSAID-induced urticaria/angioedema and bronchospasm. Acetaminophen has some COX-inhibitory activity and some patients with NSAID-induced urticaria/angioedema and bronchospasm cross-react with it. There is no simple method to manage such patients. The use of leukotrine-inhibitors have shown only limited success. The alternative treatment is desensitisation. Lately, celecoxib has been reported to be safe in aspirin-sensitive asthmatics. We hypothesized that selective inhibition of COX-2 would not lead to the development of angioedema or urticaria inducible with NSAIDs. METHOD: We identified NSAID-intolerant patients for challenge with rofecoxib, a selective COX2 inhibitor. We excluded patients who experienced concomitant bronchospasm or anaphylaxis. The patient may or may not have cross-reaction with acetaminophen. We did not challenge patients with the medications that they had reacted to. Patients had to avoid antihistamines and were free of urticaria or angioedema for at least a week prior to the challenge. The patients were given a dose of 12.5 mg of rofecoxib, followed by another 12.5 mg in an hour's time if there was no adverse reaction. RESULT: There were 11 patients. There were 3 males and the mean age of the group was 34.7 years (range 29 to 54 years). Four patients developed urticaria and 8 developed angioedema on exposure to NSAIDs; the number of prior episodes ranged from 8 to more than 10 times each. All of them reacted to acetaminophen as well. We found that all patients could tolerate rofecoxib without reaction. CONCLUSION: We showed that a COX2-selective inhibitor is safe for use in patients with NSAID-induced urticaria or angioedema. This suggests that the production of NSAID-induced urticaria and angioedema is related to COX inhibition, but it is unknown if COX- 1 inhibition alone can provoke the reaction.
410
Tolerance of Rofecoxib in Patients With Adverse Reactions to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Salvador Fernrndez-Mel~ndez*, Alfonso Miranda*, M Jose Carmona§, Juan D[az*, Jose M Barcelr*, Jose M a Vega*, Juan J Garc[a* *Allergy Section Carlos Haya Regional Hospital Civil Hospital, M~ilaga, Spain §Carlos Haya Hosp, M~ilaga, Spain BACKGROUND AND OBJECTIVE: Rofecoxib is a new NSAID that selectively inhibit cyclooxygenanse-2 enzyme (COX-2). Recently it has been published that rofecoxib can be administered to patients with aspirininduced asthma. The goal of this study was to analyze the tolerance of rofecoxib in patients with no respiratory adverse reactions to NSAIDs. PATIENTS AND METHODS: 44 patients (34 women, 10 men, average age 48 years [21-71 ]) were studied. 14 patients (32%) had urticaria, 12 (28%) urticaria-angioedema, 8 (18%) anaphylaxis, 9 (20%) angioedema and 1 (2%) generalized erythema. All patients underwent single blinded oral challenge test with placebo (first day) and rofecoxib (cumulative dose of 25 mg). RESULTS: Standard therapeutic dose of rofecoxib (25 rag) was tolerated by all 44 patients, without any adverse effects. CONCLUSION: Rofecoxib is a new drug that can be used safely in patients with no respiratory adverse reactions to NSAIDs, even though in patients with anaphylaxis symptoms.
Abstracts
Identification of T-Cell Epitopes of Cry j 1 in Dogs Sensitive to 4N~PJF'7 Japanese Cedar (Cryptomeria Japonica) Pollen Kenichi Masuda*, Masahiro Sakaguchi§, Saburo Saito~, Douglus J DeboerC, Keigo Kurata*, Sadatoshi Maeda*, Toshihiro Tsukui<,, Shigehiro lwabuchi~, Koichi Ohno*, Hajime Tsujimoto* *University of Tokyo, Bunkyo-ku, Tokyo, Japan §National Institute of Infectious Diseases, Tokyo, Japan ¥Jikei University, Tokyo, Japan ~University of Wisconsin, Madison, WI <
408
IgE Reactivity and Cross-Reactivity to Japanese Cedar (Cryptomeria Japonica) and Cypress (Chamaecyparis Obtusa) Pollen Allergens in Dogs With Atopic Dermatitis
Masahiro Sakaguchi*, Kenichi Masuda§, Hiroshi Yasueda¥, Saburo SaitoC, Douglus J Deboer~<, Hajime Tsujimoto§ *National Institute of Infectious Diseases, Tokyo, Japan §University of Tokyo, Tokyo, Japan ~qational Sagamihara Hospital, Sagamihara, Japan ~Jikei University, Tokyo, Japan <
J ALLERGY CLIN IMMUNOL JANUARY 2002
observed by the ELISA inhibition method, and Cry j 1 showed a greater inhibition than Cha o 1. We found the same findings in human patients with CJ pollinosis. In Tokyo area during the spring season, the level of airborne CJ pollen is several times that of airborne CO pollen. From these findings, sensitization to CJ pollen allergen might be predominant in humans and dogs.
f ~ O T h e Safety of Rofecoxib in Patients With NSAID-Induced Urticaria and Angioedema
4 V~F
Khai Pang Leong, Chwee Ying Tang, Bernard Thong, Hiok Hee Chng Tan Tock Seng Hospital, Singapore, Singapore BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are among the commonest drugs prescribed in the world. However, they are associated with many adverse effects, including peptic ulceration and renal impairment. Many patients are intolerant of NSAIDs and they develop asthma or urticaria/angioedema within an hour of drug exposure. Cyclooxygenase (COX) inhibition is probably the common mechanism both for NSAID-induced urticaria/angioedema and bronchospasm. Acetaminophen has some COX-inhibitory activity and some patients with NSAID-induced urticaria/angioedema and bronchospasm cross-react with it. There is no simple method to manage such patients. The use of leukotrine-inhibitors have shown only limited success. The alternative treatment is desensitisation. Lately, celecoxib has been reported to be safe in aspirin-sensitive asthmatics. We hypothesized that selective inhibition of COX-2 would not lead to the development of angioedema or urticaria inducible with NSAIDs. METHOD: We identified NSAID-intolerant patients for challenge with rofecoxib, a selective COX2 inhibitor. We excluded patients who experienced concomitant bronchospasm or anaphylaxis. The patient may or may not have cross-reaction with acetaminophen. We did not challenge patients with the medications that they had reacted to. Patients had to avoid antihistamines and were free of urticaria or angioedema for at least a week prior to the challenge. The patients were given a dose of 12.5 mg of rofecoxib, followed by another 12.5 mg in an hour's time if there was no adverse reaction. RESULT: There were 11 patients. There were 3 males and the mean age of the group was 34.7 years (range 29 to 54 years). Four patients developed urticaria and 8 developed angioedema on exposure to NSAIDs; the number of prior episodes ranged from 8 to more than 10 times each. All of them reacted to acetaminophen as well. We found that all patients could tolerate rofecoxib without reaction. CONCLUSION: We showed that a COX2-selective inhibitor is safe for use in patients with NSAID-induced urticaria or angioedema. This suggests that the production of NSAID-induced urticaria and angioedema is related to COX inhibition, but it is unknown if COX- 1 inhibition alone can provoke the reaction.
410
Tolerance of Rofecoxib in Patients With Adverse Reactions to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Salvador Fernrndez-Mel~ndez*, Alfonso Miranda*, M Jose Carmona§, Juan D[az*, Jose M Barcelr*, Jose M a Vega*, Juan J Garc[a* *Allergy Section Carlos Haya Regional Hospital Civil Hospital, M~ilaga, Spain §Carlos Haya Hosp, M~ilaga, Spain BACKGROUND AND OBJECTIVE: Rofecoxib is a new NSAID that selectively inhibit cyclooxygenanse-2 enzyme (COX-2). Recently it has been published that rofecoxib can be administered to patients with aspirininduced asthma. The goal of this study was to analyze the tolerance of rofecoxib in patients with no respiratory adverse reactions to NSAIDs. PATIENTS AND METHODS: 44 patients (34 women, 10 men, average age 48 years [21-71 ]) were studied. 14 patients (32%) had urticaria, 12 (28%) urticaria-angioedema, 8 (18%) anaphylaxis, 9 (20%) angioedema and 1 (2%) generalized erythema. All patients underwent single blinded oral challenge test with placebo (first day) and rofecoxib (cumulative dose of 25 mg). RESULTS: Standard therapeutic dose of rofecoxib (25 rag) was tolerated by all 44 patients, without any adverse effects. CONCLUSION: Rofecoxib is a new drug that can be used safely in patients with no respiratory adverse reactions to NSAIDs, even though in patients with anaphylaxis symptoms.