Positive patch test reactions to celecoxib may be due to irritation and do not correlate with the results of oral provocation.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among those therapeutics most frequently causing pseudoallergic and sometimes allergic cutaneous adverse reactions. Coxibs preferentially inhibiting cyclooxygenase-2 are increasingly propagated as alternatives in NSAID-sensitive patients. We evaluated the tolerability of celecoxib in NSAID-sensitive patients. In 14 consecutive patients (6 males, 8 females, age 18-72 years), scratch and patch tests with homogenized Celebrex were performed, followed by single-blind, placebo-controlled oral provocation (maximal single dose: 200 mg; cumulative dose: 350 mg). 8 of the first 10 patients showed erythematous reactions to celecoxib on patch testing after 2 days with decrescendo kinetics between then and day 3. 9 patients with no history of NSAID intolerance showed similar reactions. When the patch tests were repeated with homogenized Celebrex at final concentrations of 5% and 10% in petrolatum, no reaction was observed in any patient. Subsequent oral provocation was tolerated without adverse effects by all individuals. We conclude that patch tests with high concentrations of celecoxib cause irritant reactions and do not correlate with the outcome of oral provocation tests. Therefore, these tests should be performed with lower concentrations of celecoxib (Celebrex). Celecoxib itself seems to be a valuable alternative drug in NSAID-sensitive patients.