Mechanism of chronic urticaria exacerbation by aspirin

In some patients with chronic idiopathic urticaria (CIU), aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit cyclooxygenase 1 (COX-1) precipitate wheals and swelling. There is no in vitro diagnostic, and diagnosis can be established only by provocation challenges with aspir...

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Bibliographic Details
Published in:Current allergy and asthma reports 2005-07, Vol.5 (4), p.277-283
Main Authors: Mastalerz, Lucyna, Setkowicz, Malgorzata, Szczeklik, Andrzej
Format: Article
Language:English
Subjects:
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Aspirin - adverse effects
Chronic Disease
Cyclooxygenase Inhibitors - adverse effects
Drug Hypersensitivity - immunology
Drug therapy
Eicosanoids - metabolism
Humans
Leukotrienes - biosynthesis
Lipoxygenase - immunology
Nonsteroidal anti-inflammatory drugs
Prostaglandin-Endoperoxide Synthases - immunology
Signal Transduction
Urticaria - immunology
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Summary:In some patients with chronic idiopathic urticaria (CIU), aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit cyclooxygenase 1 (COX-1) precipitate wheals and swelling. There is no in vitro diagnostic, and diagnosis can be established only by provocation challenges with aspirin or other NSAIDs. Skin reactions triggered by aspirin are associated with the inhibition of cyclooxygenase, specifically COX-1, but not COX-2, and are characterized by overproduction of cysteinyl leukotrienes (cys-LTs). Aspirin and other NSAIDs should be avoided, but highly specific COX-2 inhibitors, known as coxibs, are well tolerated and can probably be safely used. Evidence has been accumulated that these reactions are due to the interference of aspirin-like drugs with arachidonic-acid metabolism. In this article, we discuss the mechanism of these reactions, and the characteristic course of aspirin-induced urticaria and its management.
ISSN:1529-7322
1534-6315
DOI:10.1007/s11882-005-0067-z