title: Aspirin allergy desensitization in cerebrovascular disease. A report of two cases, literature review and management guide for the neurointerventionalist.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center; Nashville, TN, USA - zuckerman.scott@gmail.com.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center; Nashville, TN, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Seder
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center; Nashville, TN, USA.
authors.forename: Crystiana
authors.initials: C
authors.lastname: Tsujiura
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center; Nashville, TN, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cushing
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center; Nashville, TN, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Gallup
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center; Nashville, TN, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center; Nashville, TN, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hanel
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center; Nashville, TN, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Ecker
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D055963:Asthma, Aspirin-Induced / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: allergy; aspirin; desensitization; intracranial atherosclerosis; sensitivity