Life threatening anaphylactoid reaction to celecoxib

Abstract

Rationale Antiinflammatory drugs with nonselective anti-cyclooxygenase activity may provoke severe adverse reactions in intolerant subjects. However, life threatening anaphylactoid reactions caused by selective inhibitors of the cyclooxygenase-2 isozyme are not well recognized. Methods A severe anaphylactoid reaction to celecoxib, a selective cyclooxygenase-2 inhibitor is described. Results A 37 years old healthy nonatopic female with questionable hypersensitivity to sulphonamide antimicrobials but no previous history of intolerance to nonsteroidal-antiinflammatory drugs was prescribed celecoxib (Celebrex ®) for dysmenorrhea. She used the drug for seven months with good clinical efficacy and tolerance. The following month after a single dose of celecoxib she developed general pruritus, urticaria, facial angioedema, dyspnea, abdominal pain, diaphoresis and syncope. In the emergency room she was treated with antihistamines, and discharged to home after overnight observation with the diagnosis of possible food allergy due to the proximity of the event to a meal. Benadryl and EpiPen were prescribed, however discontinuation of celecoxib was not recommended. The next month after a single dose of celecoxib she experienced the same sequence of symptoms including syncope despite immediate use of EpiPen and oral antihistamine. She recovered in a hospital following treatment with epinephrine, antihistamines and corticosteroids. Conclusions Since selective cyclooxygenase-2 inhibitors are used with increasing frequency, the medical community should be aware of the possibility of dramatic systemic anaphylactoid reactions to these agents in individuals without atopic disease, aspirin intolerance or sulphonamide-related drugs.