Aspirin is helpful in treating many conditions, from headache to heart disease.
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“However, after taking this simple wonder drug, some people experience adverse reactions,” says David Lang, MD, Chairman of the Department of Allergy and Immunology.
Called aspirin sensitivity, this condition can also be triggered by aspirin-like drugs, such as the non-steroidal anti-inflammatory drugs (NSAIDs) ibuprofen and naproxen.
Aspirin sensitivity takes three forms:
1. Aspirin sensitivity with underlying airway disease
If you have aspirin-exacerbated respiratory disease (AERD), aspirin may make you cough, wheeze and feel short of breath.
Nose or sinus congestion and drainage can stuff you up and make you sneeze.
“AERD usually begins in young adulthood, and is linked to a triad of symptoms,” says Dr. Lang:
- Chronic nasal or sinus symptoms, including polyps: Polyps (benign growths that obstruct airflow through the nose and sinuses, and impair the sense of smell) usually require sinus surgery.
- Moderate to severe asthma: Wheezing and difficulty breathing are caused by inflamed/constricted airways.
- Serious respiratory reactions to casual use: Aspirin or aspirin-like drugs can trigger reactions even if they’ve caused no trouble the past.
In AERD, aspirin does not cause symptoms, but worsens them, Dr. Lang points out.
The good news: Aspirin desensitization allows people with AERD to better tolerate aspirin, avoid respiratory symptoms and enjoy a better quality of life. Over time, it also makes sinus surgery less likely.
“Aspirin desensitization is a procedure in which tolerance to aspirin is induced. This procedure should be performed only by doctors who are knowledgeable about the procedure, at a facility equipped to manage serious respiratory reactions,” stresses Dr. Lang.
Desensitization begins with an aspirin challenge. A very low dose of aspirin is given under close medical observation.
The dose is then cautiously increased. Patients usually have one or two mild respiratory reactions, then build tolerance, which they maintain by taking aspirin daily.
“The risk of serious respiratory reaction from aspirin desensitization is outweighed by the potential benefits for people with AERD,” he notes.
2. Aspirin sensitivity with underlying skin disease
If you often get hives and swelling (a condition called chronic urticaria and angioedema), you may react adversely to aspirin — but not every time.
“Typically, one out of three times, hives and swelling will flare up after taking aspirin,” says Dr. Lang. “Again, these symptoms are not solely connected to taking aspirin.”
Unfortunately, doctors have not yet found a way to help patients with chronic hives and swelling build tolerance to aspirin.
“We usually advise these patients to avoid all aspirin and aspirin-like drugs, such as ibuprofen and naproxen, and to take acetaminophen instead,” he says.
3. Aspirin sensitivity without underlying skin or airway disease
Sometimes aspirin and aspirin-like drugs trigger hives, itching and/or swelling when there is no chronic respiratory or skin condition.
This type of aspirin sensitivity may progress to anaphylaxis, a life-threatening allergic reaction that may involve hives, swelling, difficulty breathing, a throat-closing sensation and/or lightheadedness.
Anaphylaxis requires immediate medical attention.
“Often, these patients are erroneously told, or assume, that they’re allergic to aspirin and should never take it again,” says Dr. Lang. “But with the passage of time, they may lose this tendency to react to aspirin.”
If you have this type of sensitivity, and need aspirin or an aspirin-like drug for a condition like heart disease, you may be needlessly depriving yourself of its benefits.
No skin test or blood test can predict the potential for sudden adverse reactions to aspirin. The only way to confirm this is through an aspirin challenge.
“But patients with this type of aspirin sensitivity should first see a specialist board-certified in allergy and immunology to assess the risks and benefits of aspirin re-exposure,” says Dr. Lang.
Again, the aspirin challenge must be done by an experienced team at a well-equipped facility.
Talk to your doctor
So should you stop taking aspirin, ibuprofen or naproxen if you have an adverse reaction?
Yes. But you should also talk to your doctor about your aspirin sensitivity — especially if you fall into one of the groups above.
An aspirin challenge or desensitization may allow properly selected patients to resume taking this beneficial drug.