Are You Sensitive to Aspirin? Here are Some Reasons Why

Steps you can take to better tolerate this wonder drug
Are You Sensitive to Aspirin? Here are Some Reasons Why

Contributor: David Lang, MD, Chair of  Department of Allergy and Immunology, Cleveland Clinic

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Aspirin can be very helpful in treating many conditions — from a headache to heart disease. However, when some people take this simple wonder drug, they experience one of a few types of adverse reactions, known as aspirin sensitivity.

There are three groups of patients with aspirin sensitivity:

Aspirin Exacerbated Respiratory Disease (AERD)

This first group experiences a reaction to aspirin that may include coughing, wheezing or shortness of breath. Nasal or sinus congestion, drainage and sneezing also may be present.

AERD usually begins in young adulthood and is associated with a triad of symptoms.

  • People with AERD develop chronic nasal or sinus symptoms, including nasal or sinus polyps – benign growths in the upper airway that obstruct airflow and often impair the sense of smell. Usually, sinus surgery is required.
  • Moderate-to-severe asthma also develops.
  • These patients eventually develop serious respiratory reactions to the casual use of aspirin or aspirin-like drugs. This can happen even though earlier the patient could tolerate these medications without adverse reaction. The aspirin or a non-steroidal anti-inflammatory drug, such as ibuprofen or naproxen, does not cause the initial nasal or sinus symptoms, but makes it worse.

Patients with AERD may be candidates for a procedure called aspirin desensitization. This procedure can help a patient tolerate aspirin, and allow the patient to take aspirin without respiratory reaction.

In aspirin desensitization, the patient first takes a very low dose of aspirin. Then the dose is cautiously increased.  This is done under close observation.

Patients usually experience one or two respiratory reactions to aspirin. However, since the dose  is small, these reactions are generally milder than earlier ones.

There is, however, a risk of serious respiratory reaction, so this procedure should  be performed only at a health care facility with supplies and equipment to manage a serious reaction should it occur, and under the guidance of staff and paraprofessional staff with experience with this procedure.

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Once desensitization is accomplished, the patient maintains tolerance to aspirin by taking it daily.

Aspirin desensitization treatment has been associated with improvement in AERD, including reduced nasal or sinus symptoms, improved control of asthma, improved quality of life and reduced need for sinus surgery over time.  Because of this improvement, the risk of serious respiratory reaction to aspirin is outweighed by the potential for benefit.

Aspirin Exacerbated Urticaria/Angioedema

This second group comprises patients with chronic urticaria and angioedema —  known in layman’s terms as hives and swelling.

As with patients in the first group, these conditions are not solely connected to taking aspirin. The hives and swelling flare up about a third of the time when these patients take aspirin.

Unfortunately, there is no evidence that tolerance to aspirin can be induced in this group. We usually advise that the patient avoid all aspirin and aspirin-like drugs such as ibuprofen and naproxen, and to take acetaminophen instead.

Urticaria with or without angioedema in the absence of chronic urticaria/angioedema

These patients may experience a reaction to aspirin that may include hives, swelling and itching, but in some cases the reaction may progress to anaphylaxis — a life-threatening allergic reaction that can involve hives, swelling, difficulty breathing, a sensation of the throat closing and lightheadedness. This requires immediate medical attention.

This group does not have an underlying chronic respiratory or skin condition. These patients have had reactions when taking aspirin, or in some cases an aspirin-like drug such as ibuprofen or naproxen — usually in the form of hives or swelling. They often are erroneously told or assume they are allergic to aspirin and should never take it again. However, with passage of time, the tendency to react to aspirin may no longer be present.

If you have this third form of aspirin sensitivity, and you require aspirin or an aspirin-like drug for treatment of another condition such as heart disease, you may be avoiding aspirin needlessly and depriving yourself of its benefits for no reason.

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No skin test or blood test can determine whether a person has the potential for an adverse reaction to aspirin.  The only way to find this out is to undergo an aspirin challenge procedure. In the majority of cases, aspirin can be tolerated without adverse reaction.

In an aspirin challenge, the patient first takes a very low dose of aspirin. Then the dose is cautiously increased.  The procedure is done under close observation.

Eventually patients in this third group typically are able to tolerate aspirin without adverse reaction. The reactions that do occur generally are milder than before and respond promptly to treatment.

Because of the risk of serious reaction with re-exposure to aspirin, this challenge procedure should only be performed at a health care facility where supplies and equipment are present to manage a serious reaction should it occur, and under the guidance of staff and paraprofessional staff with experience with the procedure.

It’s important that patients in this third group see  a board-certified allergy/immunology physician for an individualized assessment of the risk compared with the benefit of re-exposure to aspirin.

Talk to your doctor

So if you notice adverse reactions after taking aspirin, you should avoid taking it and other aspirin-like drugs such as ibuprofen and naproxen.

But talk to your doctor about your aspirin sensitivity — especially if you fit into groups 1 or 3 above.  You could be a candidate for undergoing an aspirin challenge.

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