Successful Use of Cyclooxygenase-2 Inhibitor in a Patient With Aspirin-Induced Asthma

Fred Marks, MD, Piedmont Health Care, Statesville, NC; Kristopher Harrell, PharmD, Rick Fischer, PharmD, Department of Clinical Pharmacy Practice, University of Mississippi Medical Center, Jackson

South Med J. 2001;94(2) 

In This Article

Abstract and Introduction

We describe the case of an aspirin-sensitive asthma patient with a history of anaphylactic reactions to nonsteroidal anti-inflammatory drugs. The patient was subsequently diagnosed with rheumatoid arthritis and treated with a cyclooxygenase (COX)-2 inhibitor without an adverse response. Current prescribing information warns to avoid using COX-2 inhibitors in aspirin-sensitive asthma patients. New evidence suggests that aspirin sensitivity may be linked to the COX-1 pathway, and COX-2 inhibitors, as a result of their selectivity, may be beneficial in patients with aspirin-induced asthma.

Aspirin, or acetylsalicylic acid (ASA), and subsequent nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used in the treatment of inflammatory processes for many years. Their anti-inflammatory actions are thought to be due to the inhibition of cyclooxygenase (COX) enzymes (COX-1 and COX-2).[1] Since their introduction, in some patients with asthma, ASA and NSAIDs have precipitated a distinct clinical syndrome of bronchospasm, rhinitis, and conjunctivitis known as aspirin-sensitive asthma or aspirin-induced asthma (AIA). Aspirin-sensitive asthma affects as many as 10% of adult asthma patients and is more common in women than in men. However, children are rarely affected; a familial pattern has not been shown.[2,3]

The exact mechanism implicated in AIA is not fully elucidated. Immunologic responses and antigen-antibody mechanisms have been debated[4,5]; however, current theories suggest inhibition of the COX pathway is most likely involved.[6,7] We report the case of a patient with a known history of anaphylactic reaction to aspirin and NSAIDs who was successfully treated with celecoxib without an adverse response.

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