Cross-reactivity to Acetaminophen and Celecoxib According to the Type of Nonsteroidal Anti-inflammatory Drug Hypersensitivity

Abstract

PurposeIdentification of tolerable alternative analgesics is crucial for management in nonsteroidal anti-inflammatory drug (NSAID)-sensitive patients. We investigated cross-reactivity of acetaminophen and celecoxib according to the type of aspirin/NSAID hypersensitivity and aimed to determine the risk factors for cross-intolerance.MethodsWe retrospectively reviewed the medical records of patients intolerant to aspirin and NSAIDs who had undergone an acetaminophen and/or celecoxib oral provocation test. Aspirin/NSAID hypersensitivity was classified into 4 types according to a recently proposed classification: aspirin-exacerbated respiratory disease (AERD), aspirin-exacerbated chronic urticaria (AECU), aspirin-induced acute urticaria/angioedema (AIAU), and NSAID-induced blended reaction (NIRD).ResultsA total of 180 patients with hypersensitivity to aspirin and NSAIDs were enrolled; 149 acetaminophen provocation test results and 145 celecoxib provocation test results were analyzed. The overall cross-reaction rates to acetaminophen and celecoxib were 24.8% and 10.3%, respectively. There was a significant difference in the cross-reactivity to acetaminophen according to the type of NSAID hypersensitivity. Cross-reactivity to acetaminophen was highest in the AECU group (43.9%), followed by the AERD (33.3%), NIBR (16.7%), and AIAU (12.5%) groups. Underlying chronic urticaria was more prevalent in patients with cross-intolerance to both acetaminophen (P=0.001) and celecoxib (P=0.033). Intolerance to acetaminophen was associated with intolerance to celecoxib (P<0.001).ConclusionsAcetaminophen and celecoxib may induce adverse reactions in a non-negligible portion of aspirin/NSAID-sensitive patients. Physicians should be aware of the possible cross-reactions of these alternative drugs and consider an oral challenge test to confirm their tolerability.

Enhanced analgesic effects of nefopam in combination with acetaminophen in rodents

“…Unlike most NSAIDs, acetaminophen administration at therapeutic doses has little or no anti-inflammatory or anti-platelet activity (29). Additionally, it does not exhibit the typical side effect profile of NSAIDs, which includes gastrointestinal tract problems and aspirininduced asthma (37,38). Although acetaminophen is among the most popular and widely used analgesics, the mechanism of its analgesic action remain uncertain, though the most suggested mechanism involves inhibition of COX activity (39).…”

Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs among Adults: Clinical Features and Risk Factors for Diagnosis Confirmation

“…in 63%). Therefore, like other researchers, we recommend a DPT to provide an assurance of tolerance before prescribing these drugs for patients with suspected NSAID HS [13,19,39,40]. …”

Aspirin-Exacerbated Respiratory Disease: Prevalence, Diagnosis, Treatment, and Considerations for the Future

“…Reactions to acetaminophen are unusual but can occur. [28][29][30][31][32] The dogma indicates that reactions in patients with AERD are triggered by the inhibition of COX-1, which is not a biologic activity of nonaspirin salicylates and, as such, dietary salicylates are generally not thought to trigger reactions. However, results of recent research showed that a low-salicylate diet perhaps leads to a reduction in symptoms in some patients with AERD.…”