Tudose Adriana Mihaela 1, Popescu F.D. 1, Vieru Mariana 1, Popescu Florica 2
1 Department of Allergology, University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania
2 Department of Pharmacology, University of Medicine and Pharmacy Craiova, Romania
Abstract
Background: A subset of chronic idiopathic urticaria (CIU) has recently been classified as autoreactive urticaria on the basis of the presence of anti-IgE and/or anti-IgE receptor antibodies. Such antibodies can be detected by skin testing with autologous serum (ASST). The clinical forms of hypersensitivity to nonsteroidal antiinflammatory drugs (NSAIDs) are rhinitis, frequently associated with nasal polyps, aspirin-intolerant asthma or nonselective NSAIDs, urticaria / angioedema, anaphylaxis and, rarely, hypersensitivity pneumonitis. In subjects with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) and autoreactive urticaria, tolerance to selective COX-2 inhibitors has not been evaluated in large series of well-phenotyped cases. Methods: We evaluated 238 patients referred to our clinic, during a 12-month period, for evaluation of chronic urticaria (more than six-week duration). Autologous serum test was performed in all these patients (ASST). From them, we selected subjects having history of hypersensitivity to NSAIDs, manifested as urticaria and/or angioedema. All patients with a history of hypersensitivity to NSAIDs underwent drug challenge test with etoricoxib. The cumulative dose was 60 milligrams. Results: One hundred thirty-three patients (55.88%) were evaluated having strong positive ASST. In this group we detected ninety-eight patients (73,68%) with a history of hypersensitivity to NSAIDs (urticaria and/or angioedema). In the group of patients with negative ASST, twenty patients had a history of hypersensitivity to NSAIDs. All patients with this history (one hundred eighteen) underwent drug challenge test for etoricoxib 60 mg total dose. Only two patients (1,69%) developed urticaria in approximately two hours after reaching the total dose. Both cases belonged to the group with positive ASST. Conclusion: The hypersensitivity to NSAIDs was more frequent in patients with positive ASST. Etoricoxib is a COX-2 selective inhibitor and appears to be well tolerated by patients with history of hypersensitivity to traditional NSAIDs (98,31%). These findings suggest that a common mechanism may be responsible for the pathogeneses of both autoreactivity and NSAID hypersensitivity in chronic urticaria. It might be further speculated that delayed, prolonged, and pronounced autoreactivity may be a possible predictor for multiple NSAID sensitivity. Patients with autoreactive urticaria should avoid all inhibitors of COX-1. These patients may use COX-2 inhibitors, after single-blinded oral challenge.