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

Case Report

A 79-year-old white woman with a history of long-standing hypertension, diabetes mellitus, hyperlipidemia, gastroesophageal reflux disease, Crohn's disease, and asthma and aspirin hypersensitivity syndrome had been seen for many years by her primary care physician. The patient had a history of nasal polyps and had intranasal ethmoidectomies, sphenoidotomies, and antrostomies in 1984. Subsequently, she was placed on a salicylate-free diet after challenge ingestion testing revealed sensitivity to salicylate-containing foods. Before 1986, she had had at least two episodes of asthma induced by both aspirin and naproxen. During the spring of 1986, she arrived at the local hospital in anaphylactic shock after having taken a 75 mg ketoprofen tablet 2 hours earlier. In the following 14 years, her primary care physician and she were careful not to use any NSAIDs.

In early January 2000, the patient had newly diagnosed rheumatoid arthritis. In February, she was seen by an orthopedist who was unfamiliar with her history and the NSAID intolerance. Consequently, the orthopedist prescribed celecoxib 200 mg daily for arthritis symptoms. The following month, the patient was seen by her primary care physician and was taking the following medications: albuterol, alendronate, amlodipine, celecoxib, lansoprazole, lorazepam, mesalamine, metformin, potassium chloride, prednisone, propoxyphene, and simvastatin. Her physician was pleased at the relief of arthritic symptoms from the newly prescribed medication, and was both shocked and relieved that the patient was for the first time treated successfully with an NSAID without having a serious adverse reaction.

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