Abstract

Objective
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. Statistical analyses were performed using chi-square, Mann–Whitney U, and Spearman correlation tests, with p < 0.05 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 non–IgE-mediated mechanisms. 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.

Key words: Celecoxib; nonsteroidal anti-inflammatory drug–exacerbated respiratory disease; safe alternative analgesic; tramadol