December 6, 2023

Why You’re Sensitive to Aspirin

A reaction to the medication may trigger preexisting asthma and result in sinus or skin reactions

Aspirin poured onto table from bottle

Aspirin is helpful in treating many conditions, from headache to heart disease. In fact, it’s estimated that in the U.S. alone, about 29 million people take the drug every day.

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But after taking this simple wonder drug, some people experience adverse reactions.

Called aspirin sensitivity, this condition can also be triggered by aspirin-like drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen and naproxen.

Reactions can include exacerbation of asthma or nasal/sinus symptoms, as well as skin reactions like hives or swelling.

Allergist David Lang, MD, explains why you may have a sensitivity to aspirin and how it may affect you.

What is an aspirin sensitivity?

While you may not use aspirin daily, you may occasionally turn to it to help with minor aches and pains or if you have a fever.

And if you have heart disease or are at risk of getting it, your healthcare provider may recommend a daily dose of aspirin. A daily regimen of aspirin may also be advised if you’re at risk of having a stroke.

Though most of us can take a dose of aspirin without any side effects, some people experience an aspirin sensitivity. Symptoms may include either a respiratory or a skin reaction: hives, itching, swelling.

So, let’s dive into how a sensitivity to aspirin affects your body. Here are the three different forms that aspirin sensitivity can take.

Aspirin sensitivity with underlying airway disease

If you have aspirin-exacerbated respiratory disease (AERD), you’ll typically develop chronic sinusitis with nasal polyps and asthma in early adulthood, and then experience a respiratory reaction to aspirin or an aspirin-like drug that may be serious.

“AERD usually begins in young adulthood, and is linked to a triad of symptoms,” says Dr. Lang. This can include the following:

  • 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 doesn’t cause symptoms. But asthma and chronic sinusitis usually requires treatment despite avoidance of aspirin and aspirin-like drugs. However, when one of these drugs is taken, respiratory symptoms can worsen dramatically, Dr. Lang points out.

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The good news? Tolerance to aspirin can be induced via a procedure called: aspirin desensitization. This allows people with AERD to tolerate aspirin and when aspirin can be taken regularly after tolerance is induced, the course of asthma and chronic sinusitis improves. Aspirin desensitization treatment has been associated with a reduction in symptoms and medication reliance and improved quality of life. Over time, this also reduces the need for sinus surgery.

“Aspirin desensitization may be associated with respiratory reaction that can be serious. 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 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,” notes Dr. Lang.

Aspirin sensitivity with underlying skin disease

If you often get hives and swelling (a condition called chronic urticaria), you may react adversely to aspirin — but not every time.

“People with chronic urticaria may have a flare of their condition after taking aspirin,” says Dr. Lang. “For this reason, we usually advise that they avoid all aspirin and aspirin-like drugs,” explains Dr. Lang. “It’s not possible to successfully desensitize these individuals.”

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.

A more serious form of this type of aspirin sensitivity may include the potential for anaphylaxis, a life-threatening allergic reaction that may involve hives, swelling, difficulty breathing, a throat-closing sensation and/or lightheadedness due to low blood pressure.

Anaphylaxis requires immediate medical attention.

“However, patients who have had reactions limited to itching and urticaria, may assume or may have been told 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.”

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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.

There is no skin test or blood test that can be used to predict the potential for such 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.

When to see a doctor

So should you stop taking aspirin, ibuprofen or naproxen if you have an adverse reaction?

Yes, says Dr. Lang. But you should also talk to a healthcare provider about your aspirin sensitivity — especially if you fall into one of the groups above.

An aspirin challenge (or desensitization in a patient with AERD) may allow properly selected patients to resume taking this beneficial drug.

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