Celecoxib-associated anaphylaxis.

Area of Science:

• Allergy and Immunology
• Pharmacology
• Clinical Medicine

Background:

• Celecoxib, a nonsteroidal anti-inflammatory drug (NSAID), is commonly prescribed for pain management.
• Patients with a history of drug allergies, including sulfonamides, require careful consideration before initiating celecoxib therapy.
• Anaphylaxis is a severe, life-threatening allergic reaction that can be triggered by various substances, including medications.

Observation:

• A healthy 27-year-old male experienced anaphylactic shock after ingesting celecoxib, despite previous tolerance.
• The patient had a history of anaphylaxis to penicillins and macrolides but tolerated sulfonamide antibiotics.
• Symptoms included systemic swelling, shortness of breath, bradycardia, and hypotension, with a recurrence after initial treatment.

Findings:

• This case represents a rare instance of immunoglobulin E-mediated anaphylaxis to celecoxib, attributed to its sulfonamide component.
• The reaction was probable based on the Naranjo probability scale, despite prior tolerance to celecoxib and sulfonamides.
• The patient's presentation included a biphasic anaphylactic response, with symptom recurrence after discharge from the emergency department.

Implications:

• Clinicians must be aware that celecoxib can induce anaphylaxis even in patients with a history of tolerating the drug or sulfonamide antibiotics.
• The potential for biphasic anaphylaxis necessitates prolonged observation and evaluation in suspected cases.
• This detailed case report underscores the importance of thorough patient history and vigilant monitoring for adverse drug reactions.