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. 2014 Mar;6(2):156-62.
doi: 10.4168/aair.2014.6.2.156. Epub 2013 Dec 13.

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

Yoon-Jeong Kim  1 , Kyung-Hwan Lim  1 , Mi-Young Kim  1 , Eun-Jung Jo  2 , Suh-Young Lee  1 , Seung-Eun Lee  2 , Min-Suk Yang  3 , Woo-Jung Song  1 , Hye-Ryun Kang  1 , Heung-Woo Park  1 , Yoon-Seok Chang  2 , Sang-Heon Cho  1 , Kyung-Up Min  1 , Sae-Hoon Kim  2
Affiliations

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

Yoon-Jeong Kim et al. Allergy Asthma Immunol Res. 2014 Mar.

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.

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

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Conflict of interest statement

There are no financial or other issues that might lead to conflict of interest.

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