Cross-reactivity between rofecoxib and naproxen

• Published in: Journal of allergy and clinical immunology Vol. 113; no. 2; p. S312
• Main Authors: Nofech-Mozes, Y., Hummel, D.B.
• Format: Journal Article
• Language: English
• Published: St. Louis Mosby, Inc 01.02.2004; Elsevier Limited
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2004.01.619

The current literature suggests that it is safe to treat patients with sensitivity and adverse reactions to cyclooxygenase (COX)–inhibitors with selective COX-2 inhibitors. We question the safety of this advice and describe a case of cross-reaction between COX-1 and COX-2 inhibitors. We describe a patient with anaphylaxis to a COX-1 inhibitor, who developed similar symptoms when orally challenged with a selective COX-2 inhibitor. A generally healthy non-asthmatic 18-year-old man was treated initially with codeine, followed 4 hours later with naproxen. 30 minutes after naproxen ingestion he developed anaphylaxis. An adverse reaction to codeine was ruled out by a negative challenge in our allergy clinic. He returned for further challenge with rofecoxib. 7 minutes after ingestion 3mg of rofecoxib he developed throat tightness, coughing, hoarseness and slight decrease in blood pressure. He responded well to epinephrine. There are only 2 descriptions in the literature of cross-reactivity between COX-1 inhibitors and selective COX-2 inhibitors: one case of anaphylaxis to rofecoxib in a patient who had a prior reaction to diclofenac-misoprostol, and one case of acute exacerbation of asthma after taking rofecoxib in a patient with known aspirin-induced asthma. This is the first patient described with cross-reactivity between naproxen and rofecoxib. Although probably very rare, cross-reactions between COX-1 inhibitors and selective COX-2 inhibitors do exist. Since such reactions could be life threatening, we believe that a provocative multi-step oral challenge test should be performed in all patients with significant adverse reactions to non-steroidal anti-inflammatory drugs prior to prescribing selective COX-2 inhibitors.