Usefulness of montelukast to prevent adverse reactions to COX-2 selective inhibitors: a case report.

Nonsteroidal anti-inflammatory drug (NSAID)-sensitivity is a frequent condition in patients with chronic urticaria and/or asthma. The physiopatologic process underlying respiratory and cutaneous reactions probably involves an increased production of cysteinyl leukotrienes. Cyclooxygenase 2 (COX-2) selective inhibitor, has been proposed as the main alternative to control pain and inflammatory diseases in these patients. However, a small percentage of patients with NSAID-induced skin reactions does not even tolerate COX-2 selective inhibitors. We report a very infrequent case of a patient with NSAID, paracetamol and COX-2 selective inhibitors sensitivity in whom we induced tolerance to paracetamol and celecoxib using the leukotriene receptor antagonist montelukast prior to oral challenges.