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Clinical Associate Professor, Department of Clinical and Administrative Sciences, Mercer University Southern School of Pharmacy, 3001 Mercer University Dr., Atlanta, GA 30341-4155, fax 678/547-6384, Marshall_L{at}Mercer.edu
Reprints: Dr. Marshall
OBJECTIVE: To report the probable association of angioedema with aspirin therapy and the selective cyclooxygenase-2 (COX-2) inhibitor rofecoxib.
CASE SUMMARY: A 44-year-old white woman, previously tolerant to
aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs), developed
angioedema of the lips after ingesting two 325-mg aspirin tablets during one
day. The reaction occurred 3 hours after taking the second aspirin and
resolved within 3 hours. Two weeks later, the patient took a 25-mg rofecoxib
tablet for a sore throat, and she developed angioedema 5
hours later.
Although the woman took 50 mg of diphenhydramine, the swelling did not
subside. She repeated the diphenhydramine dose in the evening and, by noon the
next day, 26 hours after the angioedema began, it was resolved. The
patient's internist prescribed an epinephrine auto-injector and advised her to
consult an allergist. With skin testing and oral rechallenge with aspirin, but
not rofecoxib, the allergist determined the cause of the reactions to be
aspirin-induced angioedema and selective COX-2 inhibitor intolerance. The
Naranjo probability scale indicated that aspirin was a highly probable cause
and rofecoxib was a probable cause of this patient's angioedema.
DISCUSSION: Aspirin-induced angioedema and NSAID intolerance have been well documented. There are reports of both tolerance and intolerance to selective COX-2 inhibitors in patients with documented allergy-like reactions to aspirin and NSAIDs.
CONCLUSIONS: Patients with aspirin and NSAID intolerance may develop intolerance to COX-2 inhibitors, especially with repeated exposure.
Key Words: angioedema, aspirin, celecoxib, cyclooxygenase-2 inhibitor, rofecoxib, valdecoxib
Published Online, April 5, 2005. www.theannals.com, DOI 10.1345/aph.1E546
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