mobic and Angioedema

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.

Topics: Administration, Oral; Adult; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Cyclooxygenase 2 Inhibitors; Drug Hypersensitivity; Female; Humans; Male; Meloxicam; Middle Aged; Single-Blind Method; Skin Tests; Thiazines; Thiazoles; Treatment Outcome; Urticaria

The identification of a safe and reliable alternative for patients with non-steroidal anti-inflammatory drug (NSAID)-induced urticaria/angioedema is a frequent problem for dermatologists and other practitioners. Cyclooxygenase-2 (COX-2) inhibitors have been reported to be safe for NSAID-intolerant patients from the US and Europe but not all of them have yet been approved for use in Japan. It was our objective to investigate the clinical manifestations of oral NSAID challenges in Japanese patients with histories of urticaria and/or angioedema after the intake of NSAIDs and to find safe alternative drugs, including COX-2 inhibitors and a basic anti-inflammatory drug. Twenty subjects suspected NSAID-induced urticaria/angioedema from histories were included in a double-blind or single-blind, placebo-controlled oral challenge protocol using NSAIDs. Skin prick tests using NSAIDs, which were dissolved in saline, were conducted. The mean age of the patients was 37.3 years; 14 patients were female. The results of other challenge tests showed that the most frequently intolerated drugs was loxoprofen (100%), followed by acetyl salicylic (94.4%), etodolac (53.3%), dicrofenac (50%), acetaminophen (38.5%), meloxicam (33%), and tiaramide (21.4%). Urticaria and angioedema were induced after aspirin intake in 83.3% and 22.2% of patients, respectively, whereas an asthmatic response was seen in 5.6%. Skin prick tests with NSAIDs were 100% negative. This study showed that among the NSAIDs that are available in Japan and that were investigated in this study, tiaramide, which does not inhibit COX, is the relatively safe alternative drug for Japanese patients with NSAID-induced urtiacaria and/or angioedema. Furthermore, meloxicam seems to be better tolerated than etodolac between two selective COX-2 inhibitors.

Topics: Adolescent; Adult; Aged; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Asian People; Benzothiazoles; Child; Cyclooxygenase 2 Inhibitors; Drug Hypersensitivity; Etodolac; Female; Humans; Immunologic Tests; Male; Meloxicam; Middle Aged; Piperazines; Thiazines; Thiazoles; Urticaria

Because nonsteroidal anti-inflammatory drug (NSAID) intolerance depends on COX-1 inhibition, preferential or selective COX-2 inhibitors have been thought to be well tolerated by these patients.. The aim of this study is to evaluate tolerability to nabumetone and meloxicam in patients with NSAID intolerance.. Seventy patients intolerant to NSAIDs were selected. Thirty subjects were patients with asthma with respiratory (rhinitis-asthma) intolerance to NSAIDs (group A); 40 patients (group B) had cutaneous-mucous (urticaria-angioedema) NSAID intolerance. Diagnosis was based on clinical histories in all patients, and it was confirmed by positive single-blind placebo-controlled oral challenge test in 36 patients. After written informed consent, a single-blind placebo-controlled oral challenge test with nabumetone in all patients (2 g except for 11 patients who reached 1 g) and meloxicam (15 mg) in 51 patients was performed.. Of the total selected, 94.3% tolerated 1 g nabumetone. In those who reached the 2-g dose, the tolerability was 83.6%. With respect to meloxicam, 96.1% of patients, tolerated 15 mg. No significant difference in nabumetone and meloxicam tolerability was observed between groups A and B.. The results of this study confirm a high percentage of tolerability to the maximum therapeutic dosage of nabumetone and meloxicam in patients with NSAID intolerance, both in those with cutaneous/mucous manifestations and in those with respiratory disease.. Nabumetone and meloxicam are safe alternatives in NSAID-intolerant patients.

Topics: Adult; Aged; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Asthma; Butanones; Cyclooxygenase 1; Cyclooxygenase 2 Inhibitors; Cyclooxygenase Inhibitors; Drug Resistance, Multiple; Female; Humans; Male; Meloxicam; Middle Aged; Nabumetone; Rhinitis; Single-Blind Method; Thiazines; Thiazoles

Patients with aspirin-sensitive respiratory and cutaneous diseases experience cross reactions to all nonsteroidal anti-inflammatory drugs (NSAIDs) which inhibit cyclo-oxigenase (COX) enzymes. As are now available drugs which selectively inhibit COX-2, questions are raised whether cross-reactivity occurs between aspirin and these COX 2 inhibitors.. The aim of this study was to evaluate the tolerability of three COX-2 inhibitors (meloxicam, celecoxib and rofecoxib) in subjects with previous pseudoallergic respiratory and cutaneous reactions to NSAIDs.. 76 subjects with documented previous cutaneous and respiratory pseudoallergic reactions to aspirin and/or other NSAIDs underwent a single blind challenge with celecoxib, meloxicam and rofecoxib.. All subjects with previous respiratory reactions tolerated all drugs. Three subjects with multiple-drug induced urticaria complained of a generalized reaction after challenge (Two due to celecoxib and one due to meloxicam). Among the group of patients with NSAIDs-induced urticaria five complained of a relapse of the disease due to rofecoxib (one subject), celecoxib (two subjects and meloxicam (two subjects).. According to these results the cross-reactivity between aspirin and these COX-2 inhibitors does not occur in subjects with previous respiratory pseudoallergic reactions. A good safety profile was also demonstrated in patients with cutaneous reactions, being few reactions observed. However for this reason a controlled oral challenge with these drugs is useful for the proper management of patients sensitive to classic NSAIDs.

Topics: Adolescent; Adult; Aged; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Celecoxib; Cross Reactions; Cyclooxygenase 2; Cyclooxygenase 2 Inhibitors; Cyclooxygenase Inhibitors; Drug Hypersensitivity; Female; Forced Expiratory Volume; Hemodynamics; Humans; Isoenzymes; Lactones; Male; Meloxicam; Membrane Proteins; Middle Aged; Prostaglandin-Endoperoxide Synthases; Pyrazoles; Recurrence; Rhinitis, Allergic, Perennial; Single-Blind Method; Sulfonamides; Sulfones; Thiazines; Thiazoles; Urticaria

Pseudoallergic reactions to ASA and NSAIDs in general are frequent and difficult to manage. The challenge with the suspected drug is considered unethical, therefore the only possible approach is a challenge with alternative drugs. Selective COX2 inhibitors are considered the most suitable alternative drugs. We describe the comparative results and follow-up of an oral challenge with nimesulide and meloxicam, in NSAIDs intolerant patients.. 381 patients (118 male, 263 female, mean age 53.2 years) with a well documented pseudoallergic reaction to NSAIDs underwent an oral challenge with these alternative drugs. All 381 patients were given nimesulide 88 of them were also given meloxicam. All patients were re-interviewed at six-month intervals up to two years after challenge.. 98.4% of the patients tolerated nimesulide and 95.4% tolerated meloxicam. The reactions occurred during challenges were mild and easily manageable. Three out of the six nimesulide-intolerant patients could tolerate meloxicam, whereas only one of the four meloxicam-intolerant patients could tolerate nimesulide. At the follow-up, 96% of patients with previous negative challenge could tolerate nimesulide and within the patients which took meloxicam after challenge no pseudoallergic reaction occurred.. The herein described challenge with alternative drugs, meloxicam and nimesulide, is a safe tool for the management of NSAIDs-intolerant patients. The two tested drug are safe and reliable alternatives for these patients.

Topics: Adolescent; Adult; Aged; Anaphylaxis; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Asthma; Dose-Response Relationship, Drug; Drug Evaluation; Female; Follow-Up Studies; Humans; Male; Meloxicam; Middle Aged; Safety; Single-Blind Method; Sulfonamides; Thiazines; Thiazoles; Treatment Outcome; Urticaria

Topics: Adolescent; Adult; Aged; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Drug Hypersensitivity; Female; Forced Expiratory Volume; Humans; Male; Meloxicam; Middle Aged; Thiazines; Thiazoles; Urticaria

Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) can affect children, with the mechanism proposed being inhibition of the cyclooxygenase enzyme-1 (COX-1). In these patients nonchemically related NSAIDs, including COX-2 inhibitors, can induce the reaction, hampering treatment of fever and inflammatory processes.. To analyse retrospectively tolerance to etoricoxib, a selective COX-2 inhibitor, and to meloxicam, a preferential COX-2 inhibitor, in children with hypersensitivity to NSAIDs.. Clinical records of children (aged 1-14 years) diagnosed with hypersensitivity reactions to NSAIDs from January 2006 to January 2013 were included. The diagnosis was confirmed by oral drug provocation test (DPT) with the culprit NSAIDs and acetylsalicylic acid (ASA). Tolerance to paracetamol, etoricoxib and meloxicam was also evaluated.. The study included 41 children with a positive DPT with ASA and the culprit NSAID. DPT with paracetamol and etoricoxib was negative in all children, although two (4.9%) children developed a reaction after the administration of meloxicam.. These data indicate that both etoricoxib and meloxicam are good alternatives for treatment in older children with hypersensitivity to NSAIDs.

Topics: Adolescent; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Asthma; Child; Cyclooxygenase 2 Inhibitors; Drug Hypersensitivity; Drug Substitution; Etoricoxib; Female; Humans; Male; Meloxicam; Pyridines; Retrospective Studies; Sulfones; Thiazines; Thiazoles; Urticaria

Topics: Adult; Aged; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase 2; Cyclooxygenase 2 Inhibitors; Drug Hypersensitivity; Drug Tolerance; Exanthema; Female; Humans; Meloxicam; Middle Aged; Retrospective Studies; Skin Tests; Thiazines; Thiazoles

Adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) are frequent, particularly among patients with chronic urticaria or asthma. The need to identify an alternative drug that is safe and reliable is a common problem in clinical practice.. To assess the tolerability of meloxicam, a new NSAID that selectively inhibits the inducible isoform of cyclooxygenase, in a group of NSAID-sensitive patients.. We studied 177 patients who had suffered adverse reactions to one or more NSAIDs. Cutaneous reactions were reported by 83.1% of the subjects (urticaria in 55, angioedema in 52, urticaria/angioedema in 39, and maculopapular rash in 1), respiratory symptoms by 3.9%, both cutaneous and respiratory symptoms by 9%, Stevens-Johnson's syndrome by 2.3%, and anaphylactoid reactions by 1.7%. All subjects underwent a single-blind, placebo-controlled oral challenge with divided therapeutic doses of meloxicam (1.9 mg + 5.6 mg 1 hour later = cumulative dose 7.5 mg).. Positive reactions were observed in only two cases (1.1%), both manifested exclusively by cutaneous symptoms (urticaria/angioedema in one case and maculopapular rash/facial edema in the second).. Meloxicam seems to be well tolerated by NSAID-sensitive subjects whose reactions are manifested by urticaria/angioedema. Additional study is needed for a more complete assessment of its tolerability in patients with aspirin-induced asthma and other severe manifestations of NSAID sensitivity.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anaphylaxis; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Asthma; Chronic Disease; Cyclooxygenase Inhibitors; Drug Eruptions; Female; Forced Expiratory Volume; Humans; Male; Meloxicam; Middle Aged; Thiazines; Thiazoles; Urticaria

Topics: Acetaminophen; Adult; Analgesics, Non-Narcotic; Angioedema; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Cyclooxygenase Inhibitors; Female; Humans; Male; Meloxicam; Safety; Thiazines; Thiazoles; Urticaria