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Safety of meloxicam in patients with aspirin/non‐steroidal anti‐inflammatory drug‐induced urticaria and angioedema
Author(s) -
GÖKSEL Özlem,
AYDIN Ömür,
MISIRLIGIL Zeynep,
DEMIREL Yavuz S.,
BAVBEK Sevim
Publication year - 2010
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/j.1346-8138.2010.00948.x
Subject(s) - meloxicam , medicine , angioedema , aspirin , placebo , drug , erythema , cyclooxygenase , cumulative dose , gastroenterology , pharmacology , anesthesia , surgery , alternative medicine , pathology , enzyme , biochemistry , chemistry
It has been proposed that aspirin (ASA) and other non‐steroidal anti‐inflammatory drug (NSAID)‐induced urticaria (UR)/angioedema (AE) are mediated through inhibition of cyclooxygenase‐1 (COX‐1) enzymes. Therefore, drugs with COX‐2 selectivity may be well tolerated in such patients. We investigated the safety of preferential COX‐2 inhibitor meloxicam in subjects with UR or AE type intolerance reaction to classical ASA/NSAIDs. Subjects with reliable or documented history of UR/AE due to classical ASA/NSAIDs underwent a single‐blinded, placebo‐controlled oral challenge with a cumulative dose of 7.5 mg meloxicam on 2 separate days. One‐quarter and three‐quarter divided doses of placebo and the active drug were given at 1‐h intervals. A total of 116 patients (86 women and 30 men, mean age 39.6 ± 12.7 years) were enrolled to the study. The rate of atopy was 25.9%. Mean duration of drug reaction was 87.4 ± 110.8 (1–720) months. Almost half of the patients were multi‐reactors. The most comorbid disease was asthma and the two most frequent NSAIDs inducing UR/AE were paracetamol (19. 6%) and ASA (19%). No reaction to placebo was observed. Ten out of 116 patients (8.6%) developed mild UR/AE, or only erythema and pruritus at a one‐quarter or cumulative dose of 7.5 mg of meloxicam. The remaining subjects (91.4%) tolerated perfectly meloxicam challenge. This study indicates that 7.5 mg meloxicam is a safe alternative for ASA/NSAID‐intolerant UR/AE patients. Intolerance reactions to meloxicam are much milder forms of the patients’ historical ASA/NSAID‐induced cutaneous reactions.