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ASPIRIN ALLERGY AND DESENSITIZATION
Allergic reactions to aspirin and the other nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen are common and often prevent patients from taking these useful medications. Allergic reactions to aspirin occur when the body produces antibodies (IgE) against the drug.
 
The next time the drug is ingested the antibodies bind onto the drug, trigger the immune system and lead to an allergic reaction. There are also non-allergic reactions which occur when the drug inhibits an enzyme in the body known as COX-1. While not a drug allergy, these non-allergic reactions can also lead to severe symptoms.  Both types of reactions to aspirin or NSAIDS can lead to a variety of symptoms.

Symptoms
  • Urticaria (hives)
  • Angioedema (swelling)of the lips, tongue, or face
  • Coughing, wheezing or shortness of breath
  • Itchy skin
  • Anaphylaxis – a rare, life-threatening allergic reaction
  • Runny nose

There is a subset of patients with asthma who also have sinus disease and nasal polyps. For many of these patients, aspirin or other NSAIDS lead to intense nasal, ocular and respiratory symptoms. This condition is known as Sampter’s triad or aspirin exacerbated respiratory disease (AERD). AERD tends to become more severe over time and can lead to serious health concerns such as severe asthma attacks and repetitive sinus surgery for polyp removal. Interestingly, taking daily aspirin often leads to significant improvement and, in some cases, resolution of symptoms.


Treatment
As with most drug reactions, avoidance has been the mainstay of treatment for aspirin sensitive patients. However, daily aspirin can be very helpful for a variety of health concerns such as cardiac disease and AERD. 
 
Aspirin desensitization is a well-studied and highly effective alternative to avoidance. By very slowly introducing aspirin in a controlled setting, the vast majority of patients with a history of aspirin induced reactions are able to tolerate daily aspirin. Desensitization is performed in our office under close observation by a physician and nursing staff.

The desensitization process includes:

  • Consult by a physician to determine if t
  • The patient is appropriate for desensitization
  • Thorough explanation of the procedure and associated risks
  • Lung function testing to ensure the patient’s asthma is stable prior to beginning
  • Premedication with prednisone and montelukast (Singulair) to decrease risk of reactions
  • Follow-up visit with a physician to fully explain on-going aspirin therapy

How We Can Help
Allergy Partners physicians are board certified experts in the diagnosis, treatment, and management of allergic diseases, including aspirin allergy.  If you have symptoms suggestive of aspirin reactions, your Allergy Partners physician will take a detailed history, perform a physical exam, and determine if aspirin desensitization is appropriate for you.
 
Working together, you and your Allergy Partners physician will develop a comprehensive and personalized treatment plan.