Allergy Asthma Immunol Res.  2014 Mar;6(2):156-162. 10.4168/aair.2014.6.2.156.

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

• Kim YJ
• Lim KH
• Kim MY
• Jo EJ
• Lee SY
• Lee SE
• Yang MS
• Song WJ
• Kang HR
• Park HW
• Chang YS
• Cho SH
• Min KU
• Kim SH

• KMID: 2260261
• DOI: http://doi.org/10.4168/aair.2014.6.2.156

Abstract

PURPOSE
Identification 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.
METHODS
We 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).
RESULTS
A 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).
CONCLUSIONS
Acetaminophen 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.

Keyword

Acetaminophen; celecoxib; cross reactions; hypersensitivity; intolerance; anti-inflammatory agents; non-steroidal

MeSH Terms

Acetaminophen*
Analgesics
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Aspirin
Classification
Cross Reactions
Drug Hypersensitivity*
Humans
Hypersensitivity
Medical Records
Methods
Retrospective Studies
Risk Factors
Urticaria
Celecoxib
Acetaminophen
Analgesics
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Aspirin

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