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Fernan Caballerofonseca - One of the best experts on this subject based on the ideXlab platform.

  • increased total and mite specific immunoglobulin e in patients with aspirin induced Urticaria and Angioedema
    Journal of Investigational Allergology and Clinical Immunology, 2010
    Co-Authors: M Sanchezborges, Arnaldo Caprileshulett, Nathalie Acevedo, Luis Caraballo, Fernan Caballerofonseca
    Abstract:

    ■ Abstract Background: An increased prevalence of atopy has been observed in patients with intolerance of aspirin and nonsteroidal anti-infl ammatory drugs (NSAIDs). Objective: To investigate total and mite-specifi c immunoglobulin (Ig) E in serum from patients with hypersensitivity to NSAIDs and healthy controls. Methods: Patients who reacted to 2 or more chemically unrelated NSAIDs with Urticaria and Angioedema, confi rmed by a double-blinded provocation test with aspirin, were skin tested with inhalant allergens. Total and specifi c IgE to Dermatophagoides pteronyssinus (Dp) and Blomia tropicalis (Bt) in the serum was quantifi ed by enzyme-linked immunosorbent assay (ELISA) in patients and a control group of healthy blood donors. Results: One-hundred-and-fourteen patients and 74 controls were studied. Skin tests were positive in 95 patients (83.3%). Total mean IgE levels were 107.1 (91.3) IU/mL in controls and 161.0 (150.8) IU/mL in patients (P=.006). Mean (SD) levels of IgE to Dp were 0.210 (0.17) optical density (OD) units in controls and 0.473 (0.65) OD units in patients (P=.001). Levels of specifi c IgE to Bt were 0.230 (0.20) OD units in controls and 0.522 (0.8) OD units in patients (P=.0001). Positive ELISA results for IgE to Dp were found for 29.6% of controls and 70.4% of patients (P=.0001); the corresponding percentages for Bt were 32.4% of controls and 67.6 % of patients (P=.0001). Conclusions: Cross-reactive patients with NSAID-induced Urticaria and Angioedema exhibit an increased prevalence of sensitization to Dp and Bt and increased total serum IgE. Further research is necessary to determine the reasons for this association.

  • safety of etoricoxib a new cyclooxygenase 2 inhibitor in patients with nonsteroidal anti inflammatory drug induced Urticaria and Angioedema
    Annals of Allergy Asthma & Immunology, 2005
    Co-Authors: Mario Sanchezborges, Fernan Caballerofonseca, Arnaldo Caprileshulett
    Abstract:

    Background The use of selective inhibitors of cyclooxygenase 2 (COX-2) has been shown to be safe in patients with aspirin-induced asthma. However, a few individuals with cutaneous reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) experience Urticaria or Angioedema when challenged with various coxibs. Objective To investigate the clinical tolerance of NSAID-sensitive individuals to the selective COX-2 inhibitors etoricoxib and celecoxib. Methods Patients with NSAID-induced Urticaria or Angioedema were challenged in a double-masked, placebo-controlled design protocol with etoricoxib (120 mg) and celecoxib (200 mg). Cutaneous, respiratory, and general symptoms; vital signs; and pulmonary function were monitored hourly for 3 hours. Results Fifty-eight patients (46 females and 12 males) with a mean ± SD age of 31.7 ± 14.1 years (range, 13-66 years) who showed Urticaria or Angioedema when challenged with NSAIDs were included in this study. A cutaneous clinical pattern was observed in 34 patients (59%), and a mixed pattern (cutaneous and respiratory) was seen in 24 (41%). Celecoxib provocation of 54 patients induced Urticaria in 3, Urticaria and Angioedema in 2, and Urticaria, rhinorrhea, and conjunctival erythema in 1 (reaction rate, 11.1%). Etoricoxib challenges performed in 56 patients induced Urticaria in 3 and Angioedema in 1 (reaction rate, 7.1%). Conclusions These results confirm that most NSAID-sensitive individuals with cutaneous reactions to classic NSAIDs will tolerate specific COX-2 inhibitors, supporting the use of these drugs after careful oral provocation in such patients.

  • nsaid induced Urticaria and Angioedema a reappraisal of its clinical management
    American Journal of Clinical Dermatology, 2002
    Co-Authors: Mario Sanchezborges, Arnaldo Caprileshulett, Fernan Caballerofonseca
    Abstract:

    Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs), resulting in Urticaria and Angioedema, is being observed with increasing frequency. Prevalence rates range from 0.1–0.3%, which is partly due to the large size of the exposed (at risk) population. Some predisposing factors for these cutaneous reactions have been identified, among them atopic diathesis, female sex, young adulthood, a history of chronic Urticaria and the use of the NSAID for the relief of acute pain.

Arnaldo Caprileshulett - One of the best experts on this subject based on the ideXlab platform.

  • increased total and mite specific immunoglobulin e in patients with aspirin induced Urticaria and Angioedema
    Journal of Investigational Allergology and Clinical Immunology, 2010
    Co-Authors: M Sanchezborges, Arnaldo Caprileshulett, Nathalie Acevedo, Luis Caraballo, Fernan Caballerofonseca
    Abstract:

    ■ Abstract Background: An increased prevalence of atopy has been observed in patients with intolerance of aspirin and nonsteroidal anti-infl ammatory drugs (NSAIDs). Objective: To investigate total and mite-specifi c immunoglobulin (Ig) E in serum from patients with hypersensitivity to NSAIDs and healthy controls. Methods: Patients who reacted to 2 or more chemically unrelated NSAIDs with Urticaria and Angioedema, confi rmed by a double-blinded provocation test with aspirin, were skin tested with inhalant allergens. Total and specifi c IgE to Dermatophagoides pteronyssinus (Dp) and Blomia tropicalis (Bt) in the serum was quantifi ed by enzyme-linked immunosorbent assay (ELISA) in patients and a control group of healthy blood donors. Results: One-hundred-and-fourteen patients and 74 controls were studied. Skin tests were positive in 95 patients (83.3%). Total mean IgE levels were 107.1 (91.3) IU/mL in controls and 161.0 (150.8) IU/mL in patients (P=.006). Mean (SD) levels of IgE to Dp were 0.210 (0.17) optical density (OD) units in controls and 0.473 (0.65) OD units in patients (P=.001). Levels of specifi c IgE to Bt were 0.230 (0.20) OD units in controls and 0.522 (0.8) OD units in patients (P=.0001). Positive ELISA results for IgE to Dp were found for 29.6% of controls and 70.4% of patients (P=.0001); the corresponding percentages for Bt were 32.4% of controls and 67.6 % of patients (P=.0001). Conclusions: Cross-reactive patients with NSAID-induced Urticaria and Angioedema exhibit an increased prevalence of sensitization to Dp and Bt and increased total serum IgE. Further research is necessary to determine the reasons for this association.

  • safety of etoricoxib a new cyclooxygenase 2 inhibitor in patients with nonsteroidal anti inflammatory drug induced Urticaria and Angioedema
    Annals of Allergy Asthma & Immunology, 2005
    Co-Authors: Mario Sanchezborges, Fernan Caballerofonseca, Arnaldo Caprileshulett
    Abstract:

    Background The use of selective inhibitors of cyclooxygenase 2 (COX-2) has been shown to be safe in patients with aspirin-induced asthma. However, a few individuals with cutaneous reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) experience Urticaria or Angioedema when challenged with various coxibs. Objective To investigate the clinical tolerance of NSAID-sensitive individuals to the selective COX-2 inhibitors etoricoxib and celecoxib. Methods Patients with NSAID-induced Urticaria or Angioedema were challenged in a double-masked, placebo-controlled design protocol with etoricoxib (120 mg) and celecoxib (200 mg). Cutaneous, respiratory, and general symptoms; vital signs; and pulmonary function were monitored hourly for 3 hours. Results Fifty-eight patients (46 females and 12 males) with a mean ± SD age of 31.7 ± 14.1 years (range, 13-66 years) who showed Urticaria or Angioedema when challenged with NSAIDs were included in this study. A cutaneous clinical pattern was observed in 34 patients (59%), and a mixed pattern (cutaneous and respiratory) was seen in 24 (41%). Celecoxib provocation of 54 patients induced Urticaria in 3, Urticaria and Angioedema in 2, and Urticaria, rhinorrhea, and conjunctival erythema in 1 (reaction rate, 11.1%). Etoricoxib challenges performed in 56 patients induced Urticaria in 3 and Angioedema in 1 (reaction rate, 7.1%). Conclusions These results confirm that most NSAID-sensitive individuals with cutaneous reactions to classic NSAIDs will tolerate specific COX-2 inhibitors, supporting the use of these drugs after careful oral provocation in such patients.

  • nsaid induced Urticaria and Angioedema a reappraisal of its clinical management
    American Journal of Clinical Dermatology, 2002
    Co-Authors: Mario Sanchezborges, Arnaldo Caprileshulett, Fernan Caballerofonseca
    Abstract:

    Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs), resulting in Urticaria and Angioedema, is being observed with increasing frequency. Prevalence rates range from 0.1–0.3%, which is partly due to the large size of the exposed (at risk) population. Some predisposing factors for these cutaneous reactions have been identified, among them atopic diathesis, female sex, young adulthood, a history of chronic Urticaria and the use of the NSAID for the relief of acute pain.

Mario Sanchezborges - One of the best experts on this subject based on the ideXlab platform.

  • safety of etoricoxib a new cyclooxygenase 2 inhibitor in patients with nonsteroidal anti inflammatory drug induced Urticaria and Angioedema
    Annals of Allergy Asthma & Immunology, 2005
    Co-Authors: Mario Sanchezborges, Fernan Caballerofonseca, Arnaldo Caprileshulett
    Abstract:

    Background The use of selective inhibitors of cyclooxygenase 2 (COX-2) has been shown to be safe in patients with aspirin-induced asthma. However, a few individuals with cutaneous reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) experience Urticaria or Angioedema when challenged with various coxibs. Objective To investigate the clinical tolerance of NSAID-sensitive individuals to the selective COX-2 inhibitors etoricoxib and celecoxib. Methods Patients with NSAID-induced Urticaria or Angioedema were challenged in a double-masked, placebo-controlled design protocol with etoricoxib (120 mg) and celecoxib (200 mg). Cutaneous, respiratory, and general symptoms; vital signs; and pulmonary function were monitored hourly for 3 hours. Results Fifty-eight patients (46 females and 12 males) with a mean ± SD age of 31.7 ± 14.1 years (range, 13-66 years) who showed Urticaria or Angioedema when challenged with NSAIDs were included in this study. A cutaneous clinical pattern was observed in 34 patients (59%), and a mixed pattern (cutaneous and respiratory) was seen in 24 (41%). Celecoxib provocation of 54 patients induced Urticaria in 3, Urticaria and Angioedema in 2, and Urticaria, rhinorrhea, and conjunctival erythema in 1 (reaction rate, 11.1%). Etoricoxib challenges performed in 56 patients induced Urticaria in 3 and Angioedema in 1 (reaction rate, 7.1%). Conclusions These results confirm that most NSAID-sensitive individuals with cutaneous reactions to classic NSAIDs will tolerate specific COX-2 inhibitors, supporting the use of these drugs after careful oral provocation in such patients.

  • nsaid induced Urticaria and Angioedema a reappraisal of its clinical management
    American Journal of Clinical Dermatology, 2002
    Co-Authors: Mario Sanchezborges, Arnaldo Caprileshulett, Fernan Caballerofonseca
    Abstract:

    Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs), resulting in Urticaria and Angioedema, is being observed with increasing frequency. Prevalence rates range from 0.1–0.3%, which is partly due to the large size of the exposed (at risk) population. Some predisposing factors for these cutaneous reactions have been identified, among them atopic diathesis, female sex, young adulthood, a history of chronic Urticaria and the use of the NSAID for the relief of acute pain.

Mario Sánchez-borges - One of the best experts on this subject based on the ideXlab platform.

  • Diagnosis and Treatment of Urticaria and Angioedema: A Worldwide Perspective
    World Allergy Organization Journal, 2012
    Co-Authors: Mario Sánchez-borges, Allen P. Kaplan, Riccardo Asero, Ignacio J Ansotegui, Ilaria Baiardini, Jonathan A Bernstein, G Walter Canonica, Richard Gower, David A Kahn, Connie Katelaris
    Abstract:

    Urticaria and Angioedema are common clinical conditions representing a major concern for physicians and patients alike. The World Allergy Organization (WAO), recognizing the importance of these diseases, has contributed to previous guidelines for the diagnosis and management of Urticaria. The Scientific and Clinical Issues Council of WAO proposed the development of this global Position Paper to further enhance the clinical management of these disorders through the participation of renowned experts from all WAO regions of the world. Sections on definition and classification, prevalence, etiology and pathogenesis, diagnosis, treatment, and prognosis are based on the best scientific evidence presently available. Additional sections devoted to Urticaria and Angioedema in children and pregnant women, quality of life and patient-reported outcomes, and physical Urticarias have been incorporated into this document. It is expected that this article will supplement recent international guidelines with the contribution of an expert panel designated by the WAO, increasing awareness of the importance of Urticaria and Angioedema in medical practice and will become a useful source of information for optimum patient management worldwide.

  • Safety of etoricoxib, a new cyclooxygenase 2 inhibitor, in patients with nonsteroidal anti-inflammatory drug–induced Urticaria and Angioedema
    Annals of Allergy Asthma & Immunology, 2005
    Co-Authors: Mario Sánchez-borges, Fernan Caballero-fonseca, Arnaldo Capriles-hulett
    Abstract:

    Background The use of selective inhibitors of cyclooxygenase 2 (COX-2) has been shown to be safe in patients with aspirin-induced asthma. However, a few individuals with cutaneous reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) experience Urticaria or Angioedema when challenged with various coxibs. Objective To investigate the clinical tolerance of NSAID-sensitive individuals to the selective COX-2 inhibitors etoricoxib and celecoxib. Methods Patients with NSAID-induced Urticaria or Angioedema were challenged in a double-masked, placebo-controlled design protocol with etoricoxib (120 mg) and celecoxib (200 mg). Cutaneous, respiratory, and general symptoms; vital signs; and pulmonary function were monitored hourly for 3 hours. Results Fifty-eight patients (46 females and 12 males) with a mean ± SD age of 31.7 ± 14.1 years (range, 13-66 years) who showed Urticaria or Angioedema when challenged with NSAIDs were included in this study. A cutaneous clinical pattern was observed in 34 patients (59%), and a mixed pattern (cutaneous and respiratory) was seen in 24 (41%). Celecoxib provocation of 54 patients induced Urticaria in 3, Urticaria and Angioedema in 2, and Urticaria, rhinorrhea, and conjunctival erythema in 1 (reaction rate, 11.1%). Etoricoxib challenges performed in 56 patients induced Urticaria in 3 and Angioedema in 1 (reaction rate, 7.1%). Conclusions These results confirm that most NSAID-sensitive individuals with cutaneous reactions to classic NSAIDs will tolerate specific COX-2 inhibitors, supporting the use of these drugs after careful oral provocation in such patients.

  • NSAID-Induced Urticaria and Angioedema
    American Journal of Clinical Dermatology, 2002
    Co-Authors: Mario Sánchez-borges, Arnaldo Capriles-hulett, Fernan Caballero-fonseca
    Abstract:

    Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs), resulting in Urticaria and Angioedema, is being observed with increasing frequency. Prevalence rates range from 0.1–0.3%, which is partly due to the large size of the exposed (at risk) population. Some predisposing factors for these cutaneous reactions have been identified, among them atopic diathesis, female sex, young adulthood, a history of chronic Urticaria and the use of the NSAID for the relief of acute pain. The description of two different arachidonic acid cyclo-oxygenases (COX) about a decade ago, designated COX-1 and COX-2, and the incorporation into the therapeutic armamentarium of more selective enzyme inhibitors for the control of inflammation and pain, has led to an improved understanding of the pathogenesis of adverse reactions to NSAIDs. This has allowed investigators to study ‘sensitive’ individuals to see if they can safely receive these new pharmaceutical compounds. The reasons why some people react to NSAIDs are not completely clarified. The prevalent theory about the pathogenesis of Urticaria and Angioedema due to NSAIDs in cross-reactive patients assumes that the inhibition of COX-1 leads to a shunting of arachidonic acid metabolism towards the 5-lipoxygenase pathway, which results in an increased synthesis and release of cysteinyl leukotrienes. Although COX-2 inhibitors are well tolerated by the majority of classic NSAID-sensitive patients, cutaneous reactions to highly selective inhibitors of COX-2 have been described in some of these individuals, casting some doubts about the relevance of such hypotheses. On the other hand, in patients who react to a single NSAID and chemically similar products (single-reactors), specific immunoglobulin E antibodies to haptenated NSAID metabolites have been suspected, although these metabolites are not easily demonstrated by means of routine in vivo or in vitro techniques. Facial (periorbital) Angioedema constitutes the most common form of clinical presentation, and one-third of the patients show a mixed clinical pattern of cutaneous (Urticaria and/or Angioedema) and respiratory symptoms which include upper respiratory tract edema, rhinorrhea, cough, breathlessness and tearing. When necessary, diagnosis is confirmed by means of controlled peroral drug challenges done by experienced physicians in the hospital setting and test results are helpful for clinical management, which will be based on strict avoidance, and the use of alternative tolerated medications. This approach is specially indicated in hypersensitive patients with chronic medical conditions who require continuous NSAID therapy, such as those with arthritis and coronary heart disease.

Marek Sanak - One of the best experts on this subject based on the ideXlab platform.

  • approaches to the diagnosis and management of patients with a history of nonsteroidal anti inflammatory drug related Urticaria and Angioedema
    The Journal of Allergy and Clinical Immunology, 2015
    Co-Authors: Marek L Kowalski, Katharine M Woessner, Marek Sanak
    Abstract:

    Nonsteroidal anti-inflammatory drug (NSAID)–induced Urticarial and Angioedema reactions are among the most commonly encountered drug hypersensitivity reactions in clinical practice. Three major clinical phenotypes of NSAID-induced acute skin reactions manifesting with Angioedema, Urticaria, or both have been distinguished: NSAID-exacerbated cutaneous disease, nonsteroidal anti-inflammatory drug–induced Urticaria/Angioedema (NIUA), and single NSAID–induced Urticaria and Angioedema. In some patients clinical history alone might be sufficient to establish the diagnosis of a specific type of NSAID hypersensitivity, whereas in other cases oral provocation challenges are necessary to confirm the diagnosis. Moreover, classification of the type of cutaneous reaction is critical for proper management. For example, in patients with single NSAID–induced reactions, chemically nonrelated COX-1 inhibitors can be safely used. However, there is cross-reactivity between the NSAIDs in patients with NSAID–exacerbated cutaneous disease and NIUA, and thus only use of selective COX-2 inhibitors can replace the culprit drug if the chronic treatment is necessary, although aspirin desensitization will allow for chronic treatment with NSAIDs in some patients with NIUA. In this review we present a practical clinical approach to the patient with NSAID-induced Urticaria and Angioedema.