Q:

3/20/2013
Patient is a 29 yo female who has AERD, NSAIDS worsens sinus symptom significantly. Also usual dose of Tylenol made the sinus symptom worse in the beginning and the symptom progressed as per the patient and last time patient took Tylenol developed tongue and lip angioedema which required ER visit.

Patient planning another pregnancies and is not interested in ASA desensitization. What is the best option for her for antipyretics? Have you ever used Celebrex for antipyretics in this case? Is it worth doing Celebrex challenge? Thank you.

A:

Thank you for your inquiry.

You have three alternative antipyretics. These are choline salicylate, sodium salicylate, and celecoxib (see references below). In my opinion, it is worth doing a celecoxib challenge in your patient if either sodium salicylate or choline salicylate is insufficient to control fever or pain.

Thank you again for your inquiry and we hope this response is helpful to you.

References:
Baert K, Duchateau L, De Boever S, Cherlet M, De Backer P. Antipyretic effect of oral sodium salicylate after an intravenous E. coli LPS injection in broiler chickens. Br Poult Sci. 2005 Apr; 46(2):137-43.
Source
Department of Pharmacology, Pharmacy and Toxicology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
Abstract
A study was set up to investigate the influence of sodium salicylate on fever and acute phase reaction after lipopolysaccharide (LPS) injection in broiler chickens. An acute phase reaction was provoked through the intravenous injection of Escherichia coli LPS. Four oral doses of sodium salicylate were tested. Apart from body temperature, other inflammation indices, such as plasma corticosterone and ceruloplasmin, serum thromboxane B2 and zinc concentrations were monitored. Intravenous LPS induced a fever of about 1 degree C. A dose-dependent attenuation of the fever response of the chickens in the salicylate treated groups was observed. LPS-injected chickens also showed elevated plasma corticosterone and ceruloplasmin, while serum thromboxane and zinc concentrations decreased. Except for thromboxane B2, no linear relationship with increasing salicylate dose could be shown for the other blood variables. These data confirm that sodium salicylate is an effective antipyretic agent after injection of LPS in chickens, if used at an appropriate dosage. No dose-related change could be found for the other inflammation indices.

HUNT WD. Choline salicylate as an antipyretic and analgesic in pediatric practice. Clin Med (Northfield Il). 1962 Dec; 69:2688-93.

Ramón Vargas et al: Antipyretic Effect of Celecoxib (C) in Endotoxin Induced Fever. Clinical Pharmacology & Therapeutics 1999 (February); 65:172.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology