Aspirin Allergy Research Articles

Rescue of anaphylaxis after oral aspirin ingestion

Aspirin is increasingly used to prevent platelet aggregation; however, hypersensitivity to aspirin is a high-risk of life-threatening complication. Our patient was a 52 year old male who underwent emergent splenectomy because of accidental splenic rupture and developed a severe anaphylactic reaction approximately one minute after oral aspirin ingestion to perform anti-platelet sharply rise, in accordance with the medical care during postoperative period. Acute rescue measures included intubation and large dose of dexamethasone administration. His blood pressure and SaO 2 were maintained and supported by intravenous fluids and vasoactive drugs, and he was transferred to our intensive care unit. His condition normalized and stabilized one hour after rescue and extubated then discharged uneventfully a week later. Management of aspirin and awareness of adverse effects are both very important. We propose that the timely rescue underlying aspirin allergy may be requirement of proper medical care based on the unique presentation of the patient. Emergency physicians and nurses should be prepared to rescue patients at potential risk of anaphylactic shock.

Carotid Stump as a Cause of Recurrent Embolism-Endovascular Treatment in a Case of Congenital Carotid Stump Syndrome.

Dear Sir: Cryptogenic stroke, a stroke for which there is no specific attributable cause after a comprehensive evaluation for the most common causes, accounts for about one-fourth of stroke patients. Most cryptogenic strokes are thromboembolic and occur more frequently in younger patients. There have been efforts to detect paradoxical embolism in patients with cryptogenic embolic stroke because chronic anticoagulation can effectively prevent recurrent stroke in these patients. However, other causes may also cause cryptogenic embolic stroke, and the various causes of cryptogenic strokes have been increasingly recognized recently [1]. Herein, we present a case of recurrent strokes possibly associated with a carotid stump related to congenital non-bifurcating common carotid artery (CCA) and its successful treatment using stenting. A 39-year-old man was admitted to our hospital due to recurrent ischemic strokes. He had no risk factors for stroke except for smoking. He had a history of recurrent stroke despite the use of antithrombotics. Three years ago, he had a cortical infarction in the left anterior cerebral artery area with symptoms of transient right-sided weakness and was treated with cilostazol owing to an aspirin allergy (Figure 1). One year ago, he was admitted for transient right-sided weakness and motor aphasia that lasted 5 minutes. Magnetic resonance imaging (MRI) revealed an acute cortical infarction in the left middle cerebral artery (MCA) area (Figure 1). He was treated with warfarin temporarily, and was subsequently treated with clopidogrel. Figure 1. A total of three recurrent left hemispheric strokes occurred in 3 years. (A) Diffusion-weighted imaging findings of recurrent left middle or anterior cerebral artery area cortical infarcts. The patient first had a left anterior cerebral artery cortical ... While taking clopidogrel, the patient experienced a third ischemic stroke. He presented with sensory change in the right hand. The neurologic exam result was normal, except for numbness in his right hand area. Diffusion-weighted imaging revealed an acute cortical infarction in the left MCA area and a chronic infarction in the left MCA and the anterior cerebral artery areas (Figure 1). Magnetic resonance angiography showed congenital agenesis of the left internal carotid artery (ICA) and an ICA stump. The left carotid area was supplied by a connection between the distal ICA and the external carotid artery (ECA) (Figure 1B). There was no stenotic lesion in the intracranial vessels and in the distal left common carotid artery of ECA origin. Carotid CT angiography did not show any atherosclerotic plaque in the carotid stump area. A selective left CCA injection revealed a bulbous carotid stump and turbulent flow within the ICA stump (Figure 2A). Comprehensive diagnostic work ups, including laboratory tests for coagulopathy, echocardiography with the bubble test to detect paradoxical embolism, 24-hour Holter monitoring, and coronary CT angiography for aortic pathology yielded negative results. Laboratory test for clopidogrel resistance was negative. Figure 2. Conventional angiographic findings. (A) Cerebral angiography revealed turbulent flow in the left carotid stump. (B) Stenting and stent-assisted coiling were performed across the origin of the left internal carotid artery. (C) No residual stump on postprocedure ... The decision was made to insert a stent and coil to block the stump because the patient suffered a recurrent left hemispheric stroke despite receiving antithrombotics, and only an ICA stump could be a possible source of the embolism. Stent insertion and stent-assisted coiling were successfully performed without complications (Figure 2B and ​andC).C). A closed cell-type self-expanding stent (Wall stent, Boston Scientific, Ireland) was used. The patient was discharged with triflusal and clopidogrel treatment, and remained asymptomatic at 5 months of follow-up. Carotid stump syndrome remains a rare entity, but it is a treatable cause of recurrent retinal and hemispheric symptoms after ICA occlusion. Rarely, after complete occlusion of the ICA, a short patent portion of the proximal ICA can be shown by angiography as well as by other imaging modalities, and is referred to as the “carotid stump.” In this case, congenital non-bifurcating CCA with an anomalous ECA-ICA connection, rather than acquired ICA occlusion could be the cause of the carotid stump [2]. Both surgical exclusion of the carotid stump with endarterectomy of the ECA, and carotid stenting of the distal common and external carotid arteries to exclude the ICA stump, can be used. Lakshminarayan and colleagues reported the results of a small case series that used endovascular treatment suggesting that long-term outcomes are equivalent to those achieved by surgery [3]. Our and other cases suggest that in the case of recurrent retinal or hemispheric symptoms with an ipsilateral carotid stump but no other demonstrable cause, carotid stenting with/without coiling should be considered to normalize the regional hemodynamics associated with the carotid stump.

Short-term ibuprofen treatment and pulmonary function in children with asthma.

To investigate the association between ibuprofen use and pulmonary function in children with Asthma. Ninety 9- to 10-year-old children were classified into 3 groups: Study group, mild to moderate stable asthmatic children with self-reported aspirin allergy and no history of anaphylaxis; Allergy control group: atopic children (allergic rhinitis/atopic dermatitis); Healthy control group: non-atopic healthy children. None of the participants in the atopic and healthy control groups had a history of aspirin allergy. All received ibuprofen 4 times a day for 3 consecutive days. Forced expiratory volume in the first second (FeV1) and fractional exhaled nitric oxide (FeNO) measurements were performed before and after ingestion of ibuprofen daily for 3 days. In the study group, a decrease in FeV1 and increase in FeNO levels were observed after taking ibuprofen for 2 days. The atopic control group showed only an increase in FeNO but not FEV1. In the healthy control group, both FeV1 and FeNO were unchanged from baseline. The results showed that cross-reactive non-steroidal anti-inflammatory drug hypersensitivity may exist between ibuprofen and aspirin. This raises the possibility that asthma exacerbation could be mediated by ibuprofen ingestion.

Be careful what you eat and drink; Coprinic and Kounis syndrome in a patient with the Samter`s triad

Allergic reactions to chemicals, food products or even insect bites are encountered all over the world with a variety of manifestations. Symptoms range from the development of a minor rash to life threatening anaphylactic reactions. Sometimes, acute coronary syndrome (ACS) can be registered in such patients, which may have a serious impact on the course and management of the allergic reaction. Mushroom poisoning constitutes the main portion of plant toxicities in Spain. Depending on the type of mushroom, the adverse effects range from mild gastrointestinal (GI) symptoms to major cytotoxic effects resulting in organ failure and death. Coprinopsis atramentaria poisoning is rare but with serious consequences. We report a case of a 27 year old patient with a previous history of mild persistent asthma, nasal polyps and aspirin allergy that arrived to the Emergency Department with dizziness and temor after consuming beer at a party. On arrival to the hospital, the patient suddenly collapsed, with an electrocardiogram (ECG) showing ST elevation in the inferior leads and 3rd degree atrioventricular (AV) block accompanied by urticarial-like lesions. After administration of treatment, the patient and ECG abnormalities improved. A detailed medical history showed that the patient had eaten scrambled mushrooms and beer. Expert analysis demonstrated that the combined consumption of Coprinopsis atramentaria and alcoholic beverages produced a disulfiram-like reaction (Coprinic syndrome) and type I Kounis syndrome. No case like this has been previously reported.

Ketorolac eye drop induced allergic wheal and chemosis

Ketorolac is a non-steroidal anti-inflammatory drug which is prescribed rampantly in the treatment of seasonal allergic conjunctivitis due to its clinical efficacy of providing rapid relief from symptoms of allergy. There is a potential for cross sensitivity to aspirin. Hence, a leading question on aspirin allergy must be taken before prescribing the drug ketorolac.

COX‐2 inhibitors safe to use in asthma patients with aspirin allergy

PoemFree Access COX-2 inhibitors safe to use in asthma patients with aspirin allergy First published: 30 October 2014 https://doi.org/10.1002/psb.1263AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume25, Issue2019 October 2014Pages 30-30 RelatedInformation

Abstract 385: The Impact of Aspirin Primary Prevention Treatment Guidelines: Temporal Trends in Aspirin Use for Primary vs Secondary Prevention, 2005-2013

Background: Current national prevention guidelines recommend use of low dose aspirin (ASA) for both the primary prevention (PP) and secondary prevention (SP) of heart attack and stroke. ASA use for SP has been documented to have increased over the past decade. Since the publication of the 2009 United States Preventative Services Task Force (USPSTF) recommendations for PP ASA use, data describing the trends in PP ASA use in primary care are sparse. This study evaluates trends in PP and SP ASA use in primary care clinics from a large, regional health system over an 8 year period (2005-2013). Methods: A bi-annual cross-sectional electronic medical record (EMR) chart extraction was performed from 2005 to 2013 to evaluate documented ASA use for all patient encounters within primary care clinics in the Fairview Health System (Minnesota). Primary prevention candidates were defined as individuals within the USPSTF guideline age and sex target populations (men aged 45-79, and women aged 55-79 years) with no documented history of an atherosclerotic syndrome or contraindication to ASA use (aspirin allergy, peptic ulcer disease, or concurrent antithrombotic therapy). Secondary prevention candidates were defined as adults within the same age and gender range with a history of coronary artery disease, peripheral artery disease or ischemic stroke. The ASA treatment to candidacy ratio was calculated for the PP and SP populations. Results: Over 225,000 unique encounters at 66 primary care clinics were analyzed over the 8 year study period. The PP population was younger (60.4±8.7 vs. 66.2±8.3 years), with lower prevalence of hypertension (49 vs. 79%), hyperlipidemia (54 vs. 84%), and diabetes (17 vs. 35%) compared to the SP cohort. The mean SP ASA use of 86% was high, concordant with national trends, and did not change over this period. In contrast, PP ASA average use was 44% with no increase after publication of the 2009 USPSTF guideline. Documented contraindications to ASA use were uncommon (ASA allergy, 2.1 and 2.8%; peptic ulcer disease, 3.2 and 7.2%; and use of other antithrombotic medications, 4.6 and 32.6% in PP and SP populations respectively). Conclusion: Secondary prevention ASA use in primary care settings remains high, but ASA use for primary prevention of cardiovascular events is low. Despite creation of national guidelines, aspirin use in the PP population is half the rate of ASA use for secondary prevention. Additional methods to safely and effectively disseminate this primary prevention aspirin use recommendation, targeting both the public and health care providers, are warranted.

A survey of physician practice and knowledge of drug allergy at a university medical center

A survey of physician practice and knowledge of drug allergy at a university medical center

Aspirin Allergy In a High Risk VA Population and Potential Benefit From Aspirin Desensitization

Aspirin Allergy In a High Risk VA Population and Potential Benefit From Aspirin Desensitization

Aspirin Allergy Desensitization in Cerebrovascular Disease

Aspirin (ASA) is the mainstay of treatment in cerebrovascular and systemic vascular disease. ASA hypersensitivity can pose a challenge to achieving optimum medical management prior to and after neurointerventional treatment. Desensitization to ASA is well described in the allergy and cardiovascular literature, but there are no similar discussions specific to neurointervention. The purpose of our study was to describe our experience with ASA hypersensitivity management and review the relevant literature. Two cases of patients with symptomatic cerebrovascular disease requiring neurointervention who were successfully desensitized to their ASA hypersensitivity prior to treatment are described. The subsequent literature is reviewed. Several ASA desensitization protocols exist and have been proven to successfully treat ASA hypersensitivity and allow for ASA therapy to be safely initiated. We describe several previously published protocols. ASA desensitization is a safe and simple way to manage ASA hypersensitivity. We provide comprehensive management guidelines for the neurointerventionalist engaging in ASA desensitization.

Aspirin allergy in patients with myocardial infarction: the allergist's role

Drug hypersensitivity can preclude patients from receiving the drug of choice to treat a specific illness. In some cases, such as penicillin allergy in a pregnant woman with syphilis,1 the drug is clearly indicated, and allergists may be called on to induce temporary drug tolerance (desensitize). In other cases, the medication benefit is not as clear, and allergists must weigh desensitization (DS) risks against the risks and benefits of alternative medications. For aspirin (ASA) hypersensitivity, a significant amount of literature has been published addressing scenarios in which patients with aspirin-exacerbated respiratory disease (AERD) are desensitized to ASA, but little has been published to address the issue of ASA hypersensitivity in patients with other types of ASA hypersensitivity andmyocardial infarction (MI). Of the protocols for these patients that have been published, none have been prospectively randomized, validated, or clearly documented to alter the immune system, making the diagnosis and treatment pathway unclear at times. ASA is clearly of benefit in patients with ST-segment elevation MI (STEMI) or non-STEMI.2 In patients who tolerate ASA, ASA therapy is expected; other antiplatelet agents are additions, not substitutions.3 In the era of dual antiplatelet therapy, allergists can offer cardiology colleagues a valuable service if called on to evaluate patients reporting ASA hypersensitivity.

Secondary prevention of atherosclerotic cardiovascular disease in older adults: a scientific statement from the American Heart Association.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

The utility of using fiberoptic rhinoscopy in the diagnosis of nasal polyps

BackgroundSymtomatology of nasal polyps (NP) is relatively non-specific and other nasal conditions that cause nasal may be mistaken for NP. The purpose of this study was to evaluate the accuracy otoscopic (OT) examination in detecting presence of NP by using fiberoptic rhinoscopy (FR) as the gold standard to confirm diagnosis of NP.MethodsCharts from a single allergy clinic were reviewed for any patient having NP diagnosed by FR. Data collected included gender, age, allergy skin test results, and presence of asthma, aspirin allergy, previous nasal surgeries, intranasal corticosteroid use and leukotriene receptor antagonist use.ResultsThe OT examination had 44% sensitivity. In this study, more than half (56%) of patients with NP would have had their NP missed if FR had not been performed in addition to the OT examination.ConclusionsThe standard physical examination procedure is often not sufficient to confirm a diagnosis of NP. FR should be considered in the investigation of patients with rhinitis symptoms.

Aspirin desensitization in patients undergoing percutaneous coronary intervention: A survey of current practice

Aspirin remains the mainstay of anti-platelet therapy in cardiac patients. However, if a patient is allergic to aspirin and dual anti-platelet therapy is indicated - such as with percutaneous coronary intervention (PCI), then there is no clear guidance. One possibility is aspirin desensitization. A variety of protocols exist for the rapid desensitization of patients with aspirin allergy. The aim of this survey was to assess current knowledge and practice regarding aspirin desensitization in the UK. We conducted a UK wide survey of all UK 116 PCI centers and obtained complete responses from 40 (35.4%) centers. Of these, just 7 (17.5%) centers had previously desensitised patients; 29 (87.9%) centers suggested a lack of a local protocol prevented them from desensitizing, with 10 (30.3%) unsure of how to conduct desensitization. Only 5 (12.5%) centers had a local policy for aspirin desensitization although 25 (64.1%) units had a clinical strategy for dealing with aspirin allergy; the majority (72%) giving higher doses of thienopyridine class drugs. In the UK, there appears to be no consistent approach to patients with aspirin allergy. Patients undergoing PCI benefit from dual anti-platelet therapy (including aspirin), and aspirin desensitization in those with known allergy may facilitate this. Sustained effort should be placed on encouraging UK centers to use desensitization as a treatment modality prior to PCI rather than avoiding aspirin altogether.

Complete percutaneous coronary intervention revascularization after unsuccessful surgical revascularization with allergy to aspirin

A 72-year-old diabetic (type II) patient with multivessel coronary artery disease (distal LMCA, critical LAD/D2 bifurcation stenosis, proximal OM1 stenosis and ostial PD of RCA) and normal systolic left ventricular function underwent surgical revascularization (9/2012). Since a long segment of LAD was intramural, LIMA was found to be too short so patient obtained two venous grafts — on LAD and diagonal branch. Marginal branches as well as PD were found not suitable for grafting. 48 hours later ST elevation in inferior leads was observed and urgent angiography was carried out. Grafts to LAD and D2 had a TIMI III flow, showing LAD antero- and retrogradely but with a stenosis of LAD at the point of junction. Venous graft to D2 fills retrogradely the artery as well as the median part of the LAD. In addition native D2 is shown to be significantly narrowed distally to the point of graft junction. Probable cause of the ECG changes were due do ostial PD stenosis and being a smaller caliber vessel and patient haemodinamically stable, patient was treated conservatively, than later discharged. But at outdoor control silent ischaemia was documented and new angiography performed showing disfunction of the graft to distal LAD and still normally functioning graft to D2 but with stenosis as previous. We considered complete secondary revascularization but had to face a known allergy to aspirin and the need of effective dual antiplatelet therapy in a diabetic. Our strategy was to divide interventions in two steps — firstly we did PCI on LAD with 2 DES in proximal and median segment (Xience 2,5x28 + 3,0x18) and OM with 1 BMS (Yukon 3,0x16) under the protection of enoxaparine which was changed to varfarine and 140mg of clopidogrel which was substituted by ticagrelor. The primary result was excellent. In the second act intervention on LMCA and D2 via venous graft (DES) is considered after possible desensibilization treatment for aspirin allergy that poses us now the greatest problem.

Primary PCI with endothelial progenitor cell-capture stent in patient with skull base fracture and aspirin allergy

Primary PCI with endothelial progenitor cell-capture stent in patient with skull base fracture and aspirin allergy

Aspirin Allergy in a VA Population: Is There Potential Benefit for Evaluation in the Allergy Clinic?

The prevalence of aspirin hypersensitivity reactions, including aspirin exacerbated respiratory disease (AERD), aspirin induced urticaria or angioedema, and anaphylaxis is between 0.2 to 0.9% of the general population. Aspirin is important for prophylaxis and treatment of atherosclerotic cardiovascular disease in adults but is often avoided due to reported aspirin allergies. We hypothesize that a significant proportion of reported aspirin allergic patients are candidates for aspirin desensitization or challenge.

A case of type I variant Kounis syndrome with Samter-Beer triad

Kounis syndrome is defined as the coexistence of acute coronary syndromes with situations associated with allergy or hypersensitivity, as well as anaphylactic or anaphylactoid reactions, to a variety of medical conditions, environmental and medication exposures. We report a case of Kounis-Zavras syndrome type I variant in the setting of aspirin-induced asthma, or the Samter-Beer triad of asthma, nasal polyps and aspirin allergy. When there is a young individual with no predisposing factors of atherosclerosis and apparent coronary lesion, with or without electrocardiography and biochemical markers of infarction, the possibility of Kounis syndrome should be kept in mind.

Safety of Aspirin Desensitization in Patients With Reported Aspirin Allergy and Cardiovascular Disease

Aspirin (ASA) is the drug of choice in patients with coronary artery disease for primary and secondary prevention. This poses a problem for those patients reporting hypersensitivity to this drug or class of drugs. Desensitization to ASA may be carried out safely and effectively in patients with reported ASA or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity needing ASA for cardiac indications. Our 7-step protocol is one choice for a rapid desensitization protocol. A retrospective chart review was conducted evaluating ASA desensitization in patients with reported ASA or NSAID hypersensitivity and a cardiac indication for ASA. In 160 evaluations over 15 years, 89 desensitizations were performed in both the inpatient and outpatient setting with only 16 reactions (18%). Eleven of these 16 patients (68.7%) were able to take daily ASA. Twenty-six desensitization procedures were performed with our 7-step rapid desensitization protocol in 10 inpatients and 16 outpatients with 3 reactions (18.75% of reactions). Initial reaction to ASA involving angioedema and reacting to ASA within the past year increased the risk of having a reaction to desensitization. Desensitization may be safely performed in patients with reported ASA or NSAID hypersensitivity and a cardiac indication for ASA. Our 7-step rapid protocol may be used in both the inpatient and outpatient setting to desensitize these patients. Patients who had angioedema with ASA ingestion or a reaction to ASA within the past year are at higher risk for reaction during the desensitization protocol. The authors have no funding, financial relationships, or conflicts of interest to disclose.

Aspirin Allergy in a Community Teaching Hospital

RationaleWith increasing use of cardiac stents, allergists are under demand to evaluate patients with a history of Aspirin allergy.MethodsIn an IRB approved retrospective study, we report the results of 14 patients our department evaluated with reported aspirin allergy requiring stent placement. Patients were accepted for rapid desensitization using the Wong protocol if there was a history of hives or angieodema only, but no evidence of nasal polyps. Zyrtec was given for pretreatment. In some cases, pretreatment was added with singulair, zyflo and or prednisone.ResultsIn all cases attempted, Aspirin desensitization was successful before cardiac stent placement. There were no life threatening or respiratory reactions. Only 1 patient was unable to continue aspirin. Rechallange starting at a 20mg dose was unsuccessful. Four patients had a history of respiratory complaints in the past and were pretreated with zyflo and singulair in addition to zyrtec.One patient had a history of wheezing and coughing 20 years prior on multiple occasions and was pretreated with prednisone and leukotriene blockers. He was able to attain a dosage of 81 mg .Only 1 patient was desensitized using the Scripps clinic protocol.ConclusionsSuccessful aspirin desensitization can be performed in most patients allowing successful placement of cardiac stents. Many patients report aspirin allergy leading to inappropriate withholding of aspirin.With a history of cutaneous reactions alone, the Wong protocol was uniformly successful. If there is a history of respiratory reactions, addition of zyflo, prednisone and or singulair may allow successful rapid desensitization. RationaleWith increasing use of cardiac stents, allergists are under demand to evaluate patients with a history of Aspirin allergy. With increasing use of cardiac stents, allergists are under demand to evaluate patients with a history of Aspirin allergy. MethodsIn an IRB approved retrospective study, we report the results of 14 patients our department evaluated with reported aspirin allergy requiring stent placement. Patients were accepted for rapid desensitization using the Wong protocol if there was a history of hives or angieodema only, but no evidence of nasal polyps. Zyrtec was given for pretreatment. In some cases, pretreatment was added with singulair, zyflo and or prednisone. In an IRB approved retrospective study, we report the results of 14 patients our department evaluated with reported aspirin allergy requiring stent placement. Patients were accepted for rapid desensitization using the Wong protocol if there was a history of hives or angieodema only, but no evidence of nasal polyps. Zyrtec was given for pretreatment. In some cases, pretreatment was added with singulair, zyflo and or prednisone. ResultsIn all cases attempted, Aspirin desensitization was successful before cardiac stent placement. There were no life threatening or respiratory reactions. Only 1 patient was unable to continue aspirin. Rechallange starting at a 20mg dose was unsuccessful. Four patients had a history of respiratory complaints in the past and were pretreated with zyflo and singulair in addition to zyrtec.One patient had a history of wheezing and coughing 20 years prior on multiple occasions and was pretreated with prednisone and leukotriene blockers. He was able to attain a dosage of 81 mg .Only 1 patient was desensitized using the Scripps clinic protocol. In all cases attempted, Aspirin desensitization was successful before cardiac stent placement. There were no life threatening or respiratory reactions. Only 1 patient was unable to continue aspirin. Rechallange starting at a 20mg dose was unsuccessful. Four patients had a history of respiratory complaints in the past and were pretreated with zyflo and singulair in addition to zyrtec. One patient had a history of wheezing and coughing 20 years prior on multiple occasions and was pretreated with prednisone and leukotriene blockers. He was able to attain a dosage of 81 mg .Only 1 patient was desensitized using the Scripps clinic protocol. ConclusionsSuccessful aspirin desensitization can be performed in most patients allowing successful placement of cardiac stents. Many patients report aspirin allergy leading to inappropriate withholding of aspirin.With a history of cutaneous reactions alone, the Wong protocol was uniformly successful. If there is a history of respiratory reactions, addition of zyflo, prednisone and or singulair may allow successful rapid desensitization. Successful aspirin desensitization can be performed in most patients allowing successful placement of cardiac stents. Many patients report aspirin allergy leading to inappropriate withholding of aspirin.With a history of cutaneous reactions alone, the Wong protocol was uniformly successful. If there is a history of respiratory reactions, addition of zyflo, prednisone and or singulair may allow successful rapid desensitization.