February, 2012….Sarasota, FL…. Aspirin is one of the most commonly used and well known drugs to the American public. If you include aspirin’s relatives, the non-steroidal anti-inflammatory drugs (ibuprofen, Aleve, Advil, etc), then it is likely you’d find one of these medications in every home. While the benefits of this class of drugs in treating pain, fever, and even heart disease is legend, there are a significant number of people who must steer away from them due to their allergies.
Allergic reactions to these medications are usually one of two types – skin reactions including hives and facial swelling (angioedema) or breathing difficulties (typically in patients with asthma). The skin reactors often react to a specific non-steroidal anti-inflammatory agent (NSAID) and not the whole class of drugs, including aspirin. These patients are advised to avoid the offending agent and use an alternative. In some cases of patients having ongoing hives or angioedema for other reasons, taking an aspirin or a NSAID will worsen the hives, yet in the absence of the chronic hives, the medication is tolerated just fine.
The folks that have breathing problems after an aspirin or NSAID are a more serious bunch, as the reaction can be so severe to require emergency room treatment and even hospitalization. As mentioned, this almost always occurs in people with underlying asthma, often in those with nasal polyps as well (the aspirin triad, or Samter’s disease named after a Chicago physician who first described this type of patient). Once this occurs, the entire class of anti-inflammatory drugs should be avoided, since they can all cause the same reaction. Tylenol or acetaminophen, is unrelated to these medications and can be safely used. Fewer than 3% of all asthmatics are allergic to aspirin, so we don’t routinely restrict its use, only in those that have demonstrated sensitivity.
Fortunately, for the asthmatics allergic to aspirin, studies have been done to prove that desensitizing them to aspirin is safe and can not only allow them to take the entire class of medications freely, but also many find their asthma and nasal polyps improve. Here in our Sarasota practice we have been desensitizing aspirin allergic patients since the late 1990’s. Dr. Windom led a study at the University of South Florida that established a simpler protocol for aspirin desensitization, ideal for the outpatient clinic. That protocol is still being used here and elsewhere around the country. After a series of six weekly, two hour office visits wherein a gradually increasing dose of aspirin is administered, patients are maintained on daily aspirin at home. With the allergy ‘turned off’ they can then take other NSAID’s as needed for aches and pains.
Allergies to aspirin or other anti-inflammatory medicine is treatable and should not be viewed as a forever problem.