Abstract
Aims: Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) has various mechanisms and represents different clinical syndromes from anaphylaxis to severe bronchospasm. The prevalence of aspirin hypersensitivity among patients with asthma and nasal polyps reaches 25.6%. Respiratory reactions associated with aspirin or other NSAIDs are not immunological. The basis of these reactions is non-allergic hypersensitivity of the cross-reactive type. Desensitization followed by long-term aspirin therapy is an effective method of treating hypersensitivity to aspirin or other NSAIDs. Using aspirin 600-1200 mg/day can significantly alleviate the symptoms of asthma, allergic rhinitis. Methods: We successfully applied aspirin desensitization for method of patients with hypersensitivity to NSAIDs. According to the method, an hour before the desensitization, daily montelukast 10 mg was taken orally, then aspirin every 3 hours. Results: Three patients underwent desensitization of aspirin. The dose was selected individualy depending on the clinical manifestations of drug-induced adverse reactions (AR). ARs during desensitization were treated by iv dexamethasone administration. Subsequent doses did not cause AR. Doses of aspirin were increased to a maximum of 1250 mg daily, and were continued for the long-term use. Conclusion: It is possible to conclude that the initial dose of aspirin should be 16-40mg; it is possible to increase the dose if the initial dosage is well tolerated; symptoms of moderate intolerance are treated by 4-8 mg iv dexamethasone; prior to desensitization, we recommended to use montelukast 10 mg, it is safe to practice desensitization of aspirin according to a personalized technique by a specialist in an intensive care unit.
Highlights
Skin reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) occur in 3.5% of population, and the prevalence of hypersensitivity to ASA can reach 27-35% among patients with chronic urticaria
Conduction of desensitization: The 1st dose was taken orally on 23.10.18 – 18 mg; the patient did not present any complaints; the 2nd dose was 37 mg; the patient did not present any complaints; the 3rd dose – 75mg; 30 minutes after receiving the 3rd dose, the patient developed nasal congestion, rhinorrhea, sneezing, difficulty breathing; these symptoms were arrested with 4 mg of dexamethasone i/v by stream infusion; the 4th dose was 150 mg; the patient did not present any complaints
Three patients were desensitized with acetylsalicylic acid, and desensitization was personalized by nature
Summary
Aims: Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) has various mechanisms and represents different clinical syndromes from anaphylaxis to severe bronchospasm. The disorders of arachidonate metabolism are as follows: 1) increased levels of leukotriene E4 in urine, expired breath condensate, bronchoalveolar lavage, induced phlegm and saliva due to increased 5-lipoxygenase activity; 2) decreased production of prostaglandin E2 by the epithelium of the upper and lower respiratory tract, accompanied by the inhibition of COX-2 and reduced basal production of lipoxin A4 by peripheral blood leukocytes; 3) increased expression of type 1 leukotriene receptors by the nasal mucosa cells [3] To cite this English version: A.V. Lavrenko, Ya.M. Avramenko, O.A. Borzykh, I.P. Kaidashev Personalized desensitization with acetylsalicylic acid in patients with hypersensitivity to non-steroidal anti-inflammatory drugs// The Medical and ecological problems. Kaidashev Personalized desensitization with acetylsalicylic acid in patients with hypersensitivity to non-steroidal anti-inflammatory drugs// The Medical and ecological problems. – 2020. - Vol 24, No 1-2. - P. 40-43
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