Aspirin sensitivity: implications for patients with coronary artery disease.
BACKGROUND
Although acetylsalicylic acid (aspirin) is commonly used for patients with chronic cardiovascular disease, a minority of patients have a sensitivity to acetylsalicylic acid and other nonsteroidal anti-inflammatory drugs.


OBJECTIVE
To provide a diagnostic strategy for evaluating and treating patients with aspirin sensitivity, with additional consideration for issues specific to patients with coronary artery disease (CAD).


METHODS
Published articles were identified through a search of MEDLINE and the Cochrane databases using the dates 1966 to June 2004 and the search terms aspirin allergy, coronary artery disease, aspirin desensitization, and aspirin sensitivity. References of retrieved articles were also reviewed for pertinent studies. Articles were included in this review if they were controlled studies, published in the English language, and appeared in a peer-reviewed journal.


RESULTS
The prevalence of aspirin-exacerbated respiratory tract disease is approximately 10% and for aspirin-induced urticaria the prevalence varies from 0.07% to 0.2% of the general population. Aspirin sensitivity is most often manifested as rhinitis and asthma or urticaria/angioedema induced by cross-reacting nonsteroidal anti-inflammatory drugs that inhibit cyclooxygenase 1. The primary mechanism of sensitivity is less often related to drug-specific IgE antibody production leading to urticaria/angioedema and rarely to anaphylaxis. Most patients with acetylsalicylic acid sensitivity are able to undergo desensitization therapy safely and successfully except in cases of chronic idiopathic urticaria. However, there have not been any randomized trials that specifically focus on the efficacy of aspirin desensitization. Furthermore, experience with acetylsalicylic acid desensitization in patients with CAD is very limited. After successful desensitization, acetylsalicylic acid therapy must be indefinitely continued to prevent resensitization.


CONCLUSIONS
Acetylsalicylic acid sensitivity is common and desensitization can be performed safely in many patients. Large-scale trials are warranted to determine the safety and efficacy of acetylsalicylic acid desensitization therapy in patients with concomitant CAD because data are currently limited to small case series.
Gollapudi
Raghava R
RR
Divison of Cardiovascular Diseases, Scripps Clinic and the Scripps Research Institute, La Jolla, Calif 92037, USA.
Teirstein
Paul S
PS
Stevenson
Donald D
DD
Simon
Ronald A
RA
D000465:Algorithms; D000707:Anaphylaxis / Q000139:chemically induced; D000799:Angioedema / Q000139:chemically induced; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D001249:Asthma / Q000139:chemically induced; D003324:Coronary Artery Disease / Q000517:prevention & control*; D051545:Cyclooxygenase 1; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008565:Membrane Proteins; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D011451:Prostaglandin-Endoperoxide Synthases; D012220:Rhinitis / Q000139:chemically induced; D014581:Urticaria / Q000139:chemically induced
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D010975:Platelet Aggregation Inhibitors; D051545:Cyclooxygenase 1; C496511:PTGS1 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D001241:Aspirin