DÄ internationalArchive20/2008Salicylate Intolerance – Pathophysiology, Clinical Spectrum, Diagnosis and Therapy: Some Additional Comments

Correspondence

Salicylate Intolerance – Pathophysiology, Clinical Spectrum, Diagnosis and Therapy: Some Additional Comments

Dtsch Arztebl Int 2008; 105(20): 384. DOI: 10.3238/arztebl.2008.0384a

Stichtenoth, D O

LNSLNS Inhibition of cyclooxygenase (COX) is correctly described as the cause of intolerance to acetylsalicylic acid (ASS) and other non-steroidal antirheumatic drugs (NSAR). Nevertheless, the term "salicylate intolerance" gives a misleading impression of the pathological mechanism. The feature common to the drugs which cause this effect is not the chemical structure, but rather the mechanism of action as COX inhibitor (1). In contrast to ASS, a potent and irreversible inhibitor of COX-1 and COX-2, the non-acetylated salicylates are only very weak and reversible inhibitors of the two COX isoenzymes (2). This is of direct clinical significance, as patients with severe ASS intolerance develop no, or only slight, symptoms after treatment with non-acetylated salicylates, such as disalycilic acid (salsalate), which is commonly used in the USA (3).

The author recommends that it is particularly important to avoid COX-1 inhibitors. We concur with this, although it should be explicitly mentioned that the intolerance reaction is triggered by inhibi-tion of COX-1 (3). Studies on patients with ASS/NSAR intolerance have found that highly selective COX-2 inhibitors (coxibs) provide a safe therapeutic option for these patients (1, 3). As a legal precaution, the summaries of product characteristics for the coxibs still include the contraindication "ASS/NSAR intolerance", as for all NSARs. DOI: 10.3238/arztebl.2008.0384a


Prof. Dr. med. Dirk O. Stichtenoth
Vu Vi Pham
Institut für Klinische Pharmakologie
Medizinische Hochschule Hannover, 30623 Hannover, Germany
Stichtenoth.Dirk@mh-hannover.de

Conflict of interest statement
Prof. Stichtenoth has received travel and lecture fees from the firms Abbott,
MSD, Novartis and Pfizer.
Vu Vi Pham declares that no conflict of interest exists according to the guidelines of the Interna-tional Committee of Medical Journal Editors.
1.
Randerath WJ, Galetke W: Differenzialdiagnose der rezidivierenden Polyposis nasi: Das Analgetika-Asthma-Syndrom. Dtsch Arztebl 2007; 104(46): A 3178–83.
2.
Frölich JC: A classification of NSAIDs according to the relative inhibition of cyclooxygenase isozymes. Trends Pharmacol Sci 1997; 18: 30–4. MEDLINE
3.
Stevenson DD, Szczeklik A: Clinical and pathologic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol 2006; 118: 773–86. MEDLINE
1. Randerath WJ, Galetke W: Differenzialdiagnose der rezidivierenden Polyposis nasi: Das Analgetika-Asthma-Syndrom. Dtsch Arztebl 2007; 104(46): A 3178–83.
2. Frölich JC: A classification of NSAIDs according to the relative inhibition of cyclooxygenase isozymes. Trends Pharmacol Sci 1997; 18: 30–4. MEDLINE
3. Stevenson DD, Szczeklik A: Clinical and pathologic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol 2006; 118: 773–86. MEDLINE