Tolerability of Nimesulide and Paracetamol in Patients With Nsaid-Induced Urticaria/Angioedema

Abstract

Previous studies evaluated the tolerance of nimesulide and paracetamol in subjects with cutaneous, respiratory and anaphylactoid reactions induced by nonsteroidal anti-inflammatory drugs (NSAIDs). In this study we investigated tolerability and reliability of nimesulide and paracetamol in a very large number of patients with an exclusive well-documented history of NSAID-induced urticaria/angioedema. Furthermore, we evaluated whether some factors have the potential to increase the risk of reaction to paracetamol and nimesulide. A single-placebo-controlled oral challenge procedure with nimesulide or paracetamol was applied to 829 patients with a history of NSAID-induced urticaria/angioedema. A total of 75/829 (9.4%) patients experienced reactions to nimesulide or paracetamol. Of the 715 patients tested with nimesulide 62 (8.6%) showed a positive test, while of 114 subjects submitted to the challenge with paracetamol, 13 (9.6%) did not tolerate this drug. Furthermore, 18.28% of patients with a history of chronic urticaria and 11.8% of subjects with an history of NSAID-induced urticaria/angioedema or angioedema alone (with or without chronic urticaria) resulted to be intolerant to alternative drugs. Taken together, our results confirm the good tolerability of nimesulide and paracetamol in patients who experienced urticaria/angioedema caused by NSAIDs. However, the risk of reaction to these alternative study drugs is statistically increased by a history of chronic urticaria and, above all, by a history of NSAID-induced angioedema.

Hypersensitivity reactions to paracetamol in children: a study of 25 cases

“…(14) diagnosed paracetamol HS in 9.6% of the patients with a well‐documented HS to NSAIDs. Risk of paracetamol HS was increased in atopic patients, in patients with allergic‐like reactions to antimicrobial drugs, and in patients with immediate and/or anaphylactic reactions to paracetamol (14, 23, 24). In our study, only one child was diagnosed hypersensitive to paracetamol.…”

“…However, immediate and accelerated urticaria and/or angioedema, dyspnea and rhinitis (3–8), and rare allergic and nonallergic anaphylactic reactions (3, 9–12), have been reported in children and adults. Most reactions to paracetamol occur in patients with a nonallergic HS to nonsteroidal anti‐inflammatory drugs (NSAIDs) (13, 14). However, in a few patients, reactions result from an allergic HS, with tolerance to acetylsalicylic acid (ASA) and other NSAIDs (5, 15–17).…”

Benzydamine: an alternative nonsteroidal anti‐inflammatory drug in patients with nimesulide‐induced urticaria

“…Our data allow us to conclude that benzydamine is a tolerable NSAID and together with other NSAIDs such as floctafenine (17) and meloxicam (18–19) whose tolerability has been demonstrated, it may be considered a valid alternative in patients with NSAIDs adverse reactions. Moreover, it may be considered a valid alternative in those patients highly reactive to NSAIDs and in those who react against nimesulide as well.…”

Periorbital Hyperpigmentation, a Dermatologic Condition Having a Strong Geographic and Ethnic Determinism

“…Accompanying symptoms are redness, excessive lacrimation, blurred vision, local itching, which distinguishes him from non-allergic eyelid edema, without the immunologic intervention [33]. Angioedema is a known cause of eyelid edema, but the brutality, speed and intensity of the phenomenon eliminates any confusion in the diagnostics [34].…”