What Is an Aspirin Allergy?

Risk is especially high in persons with severe asthma

Aspirin Allergies
Allergic reactions to aspirin and NSAIDs are fairly common. Last Resort Collection/Photodisc/Getty Images

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drug whose function it is to reduce pain, decrease fever, and, in higher doses, decrease inflammation. Aspirin was the first NSAID produced in the 1800s from chemicals isolated from the bark of the willow tree.

For all of its proven effects, aspirin is known to cause an allergic reaction in some people. Moreover, an allergy to aspirin often translates to allergies to other types of NSAID including ibuprofen (Advil, Motrin) and naproxen (Aleve).

NSAID allergy is believed to affect one percent of the general population. Moreover, as many as one in ten people with asthma will experience a worsening of symptoms after taking a NSAID. For those whose asthma is accompanied by chronic sinusitis and nasal polyps, the risk can increase to as high as 40 percent.

Understanding Aspirin Allergy

Aspirin allergy is characterized by three different reactions, each with their own unique set of features. The reactions can sometimes overlap resulting in symptoms ranging from mild to life threatening. These include:

  • Aspirin-exacerbated respiratory disease (AERD), which causes symptoms such as rhinitis and asthma
  • Aspirin-exacerbated urticaria/angioedema, which manifests with dermatological symptoms such as hives and swelling
  • Aspirin-exacerbated urticaria with or without angioedema, in which hives and swelling can progress to a potentially life-threatening, all-body reaction known as anaphylaxis.

    Less commonly, NSAIDs are known to trigger serious conditions such as aseptic meningitis and hypersensitivity pneumonitis, although the mechanisms of these responses are not entirely understood.

    Diagnosing Aspirin Allergy

    Allergies to pollens, cat dander, and foods can be diagnosed by testing the blood for so-called allergic antibodies.

    This type of antibody response does not usually occur with NSAIDs. As such, allergies of this sort are most often diagnosed presumptively based on the appearance and timing of symptoms.

    In severe cases, an oral challenge test may be used to see how a person reacts to a specific NSAID. This should only be done under the supervision of a certified allergist.

    Treating Aspirin Allergy

    The main focus of treatment is the avoidance of any NSAID known or believed to cause allergy. This is especially true for persons with extreme hypersensitivity. This not only includes the avoidance of aspirin tablets and capsules but any product containing aspirin, including Alka Selzer, Vanquish, Pepto-Bismol, Kaopectate, Maalox, Doan’s, Sine-Off, and Pamprin.

    By contrast, acetaminophen (Tylenol) is generally considered safe as are COX-2 inhibitors such as celecoxib (Celebrex).

    Aspirin Desensitization

    In certain situations, an adjusted form of aspirin therapy may be used to help a person overcome hypersensitivity. One such example involves persons with severe asthma who require surgery to remove nasals polyps. After undergoing the procedure, doctors will sometimes recommend aspirin desensitization to help those with AERD better enjoy the benefits of aspirin.

    The procedure aims to decrease aspirin sensitivity by exposing the individual to very low doses of aspirin and then gradually increasing the dose until he or she is able to tolerate 650 milligrams. This should only be done under the care of a qualified allergist and only in persons for whom aspirin would provide much-needed relief.

    Source:

    Lee, R. and Stevenson, D. "Aspirin-Exacerbated Respiratory Disease: Evaluation and Management." Allergy Asthma Immunol Res. 2011; 3(1): 3-10.

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