Safe analgesic alternatives in patients with NSAID-exacerbated respiratory disease: The role of tramadol and celecoxib

Abstract

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.