Approach to "aspirin allergy" in cardiovascular patients.

Abstract

Aspirin (ASA), by irreversibly inhibiting platelet cyclooxygenase-1 enzyme (COX-1), prevents platelet aggregation and is the mainstay of pharmacotherapy of patients with coronary artery disease (CAD). Long-term ASA therapy reduces mortality in CAD patients after an initial coronary event. Periprocedural ASA therapy significantly reduces major adverse cardiovascular events (MACE) after percutaneous coronary interventions.1,2 Despite a plethora of clinical data showing marked efficacy of ASA therapy in cardiovascular patients, ASA use continues to be less than optimal in real-world registries.3,4 A history of adverse reactions to ASA may prevent long-term use in a cardiovascular patient, thereby reducing optimal event protection. Most adverse reactions to ASA, such as gastrointestinal intolerance, are predictable and are dose and host related.5 However, ASA can also cause a hypersensitivity reaction, of which there are 3 types: respiratory sensitivity (asthma and/or rhinitis), cutaneous sensitivity (urticaria and/or angioedema), and systemic sensitivity (anaphylactoid reaction).6 Various terms have been used to describe the hypersensitivity reactions to ASA, including ASA intolerance, ASA idiosyncrasy, pseudoallergic reactions, and ASA sensitivity.7 The prevalence of ASA sensitivity in cardiovascular patients is not well known. Besides substitution with an alternative class of antiplatelet agents such as thienopyridines, ASA desensitization is an option for ASA-allergic patients who require long-term therapy for cardiovascular diseases.7 In this article, we review various hypersensitivity reactions to ASA and discuss desensitization protocols to allow ASA therapy in ASA-sensitive cardiovascular patients. ### ASA-Exacerbated Respiratory Disease ASA-exacerbated respiratory disease (AERD) is a triad of asthma, ASA sensitivity, and rhinitis/nasal polyps. Patients with AERD have aggressive mucosal inflammation and suffer from precipitation of asthma and rhinitis after ingestion of ASA and nonsteroidal antiinflammatory drugs (NSAIDs).8 AERD is also commonly referred to as ASA-sensitive, ASA-induced, or ASA-intolerant asthma. AERD is the cause of 10% to 15% of all cases of asthma,8 is usually …