D2.247 - Sensitization to Meloxicam, Celecoxib and Paracetamol in patients intolerant to non-steroidal antiinflamatory drugs (NSAIDS)

Since nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for various medical conditions, there is a need for safe alternative NSAIDs for individuals with hypersensitivity reactions. However, although these alternative drugs are generally considered safe, they are not entirely risk-free. We attempted to show that there are patients who, in addition to having intolerance to NSAIDs, are also sensitized to meloxicam, celecoxib and paracetamol.

A total of 132 patients considered intolerant to NSAIDs based on the clinical history and/or a positive exposure with acetylsalicylic acid (ASA) or other NSAID were studied. Three controlled challenge tests were made in all of them using meloxicam 15 mg, celecoxib 400 mg and paracetamol 2 g.

All three drugs tested were tolerated by 122 of the 132 patients (92,4%). During the study period (2024), 316 oral provocation tests (OPT) with alternative drugs were performed. OPT was conducted with meloxicam and celecoxib in 100% of patients, and paracetamol in 40% of patients (since 80 patients used paracetamol safely at home, no tests were performed with this drug). Reactions were observed in 10 patients (7.58%) (8 females, median age of 45 years [range: 17–77]). A total of 10 reactions were observed, 6 were associated with meloxicam, 3 with paracetamol, and 1 with celecoxib. The positive reactions consisted of 50% angioedema, 20% respiratory symptoms, 10% urticaria, and 10% anaphylaxis. The reaction latency was less than 24 hours in 60% of cases. Additionally, 70% of patients sought emergency care after the OPT. 

Meloxicam, celecoxib and paracetamol can be considered safe alternative drugs in most patients with NSAID hypesensitivity. However, caution should still be exercised when performing controlled exposure tests, even when administering drugs considered to be very safe. These should always be initially administered in specialized units before their use is recommended.