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Tolerance to alternative cyclooxygenase-2 inhibitors in nonsteroidal anti-inflammatory drug hypersensitive patients

Wendy SJ Malskat12, André C Knulst1, Carla AFM Bruijnzeel-Koomen1 and Heike Röckmann1*

Author Affiliations

1 Department of Dermatology/Allergology, University Medical Centre Utrecht, Heidelberglaan 100, G 02.124, Utrecht 3584 CX, The Netherlands

2 Current Address: Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands

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Clinical and Translational Allergy 2013, 3:20  doi:10.1186/2045-7022-3-20

Published: 24 June 2013



Non-steroidal anti-inflammatory drugs (NSAIDs) frequently cause adverse drug reactions. Many studies have shown that drugs which selectively inhibit the cyclooxygenase-2 enzyme (COX-2) are safe alternatives in the majority of patients. However, hypersensitivity reactions to COX-2 inhibitors have been published. Hardly any data are available regarding the safety of alternatives in case of COX-2 inhibitor hypersensitivity. We aimed to investigate the tolerance to COX-2 inhibitors in patients with non-selective NSAID hypersensitivity. Furthermore, in COX-2 hypersensitive patients tolerance of a second COX-2 inhibitor was investigated.


We retrospectively analyzed 91 patients with proven non-selective NSAID hypersensitivity that underwent oral challenges with a COX-2 inhibitor. Patients with intolerance to the first challenged COX-2 inhibitor received a second challenge with a different COX-2 inhibitor.


19 out of 91 (21%) patients had a positive reaction to the first oral challenge with a COX-2 inhibitor. 14 of them underwent a second challenge with a different COX-2 inhibitor and 12 (86%) did not react.


A relatively high percentage (21%) of the non-selective NSAID hypersensitive patients did not tolerate a COX-2 inhibitor and oral challenge is advised prior to prescription of a COX-2 inhibitor. For the majority of patients reacting to a COX-2 inhibitor an alternative can be found.

COX-2; Drug hypersensitivity; Nonsteroidal anti-inflammatory drugs; Oral provocation