Safe analgesic alternatives in patients with NSAID-exacerbated respiratory disease: The role of tramadol and celecoxib
Annals of Medical Research, cilt.33, sa.3, ss.99-103, 2026 (TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 33 Sayı: 3
- Basım Tarihi: 2026
- Doi Numarası: 10.5455/annalsmedres.2025.10.332
- Dergi Adı: Annals of Medical Research
- Derginin Tarandığı İndeksler: TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.99-103
- İnönü Üniversitesi Adresli: Evet
Özet
Aim: This study aimed to determine which analgesic agents can be safely administered to patients with nonsteroidal anti-inflammatory drug--exacerbated respiratory disease (N-ERD) and to evaluate the safety of tramadol as a potential alternative. Materials and Methods: A total of 51 patients (34 females, 17 males; mean age 39.5 ± 14.2 years) with a history of NSAID hypersensitivity were retrospectively analyzed. All patients underwent oral drug provocation tests with celecoxib, paracetamol, nimesulide, meloxicam, and tramadol. In patients with a history of hypersensitivity to a single NSAID, negative skin test results were followed by an oral aspirin challenge to confirm N-ERD. Reaction rates among analgesics were compared using Cochran’s Q test, followed by Dunn--Bonferroni pairwise analysis. A p-value <0.05 was considered statistically significant. Results: Eleven patients (21.6%) had hypersensitivity to a single NSAID; all demonstrated negative skin test results but positive aspirin challenge outcomes, indicating a non--IgE-mediated mechanism. Celecoxib and tramadol showed significantly lower reaction rates compared with nimesulide, paracetamol, and meloxicam (p<0.001). More than half of the cohort (52.9%) required moderate- or high-dose inhaled corticosteroids, while 25.5% of patients with severe asthma were receiving biologic therapy. Conclusion: Celecoxib and tramadol were well tolerated in all patients with N-ERD, suggesting that these agents are safe and effective analgesic alternatives. Individualized evaluation and supervised provocation testing remain essential to ensure safety before clinical use.