title: Clinical approach on challenge and desensitization procedures with aspirin in patients with ischemic heart disease and nonsteroidal anti-inflammatory drug hypersensitivity.
abstract: BACKGROUND
  Hypersensitivity to acetylsalicylic acid (ASA) constitutes a serious problem for subjects with coronary artery disease. In such subjects, physicians have to choose the more appropriate procedure between challenge and desensitization. As the literature on this issue is sparse, this study aimed to establish in these subjects clinical criteria for eligibility for an ASA challenge and/or desensitization.
  
  
  METHODS
  Collection and analysis of data on ASA challenges and desensitizations from 10 allergy centers, as well as consensus among the related physicians and an expert panel.
  
  
  RESULTS
  Altogether, 310 subjects were assessed; 217 had histories of urticaria/angioedema, 50 of anaphylaxis, 26 of nonimmediate cutaneous eruptions, and 17 of bronchospasm related to ASA/nonsteroidal anti-inflammatory drugs (NSAID) intake. Specifically, 119 subjects had index reactions to ASA doses lower than 300 mg. Of the 310 subjects, 138 had an acute coronary syndrome (ACS), 101 of whom underwent desensitizations, whereas 172 suffered from a chronic ischemic heart disease (CIHD), 126 of whom underwent challenges. Overall, 163 subjects underwent challenges and 147 subjects underwent desensitizations; 86 of the latter had index reactions to ASA doses of 300 mg or less. Ten subjects reacted to challenges, seven at doses up to 500 mg, three at a cumulative dose of 110 mg. The desensitization failure rate was 1.4%.
  
  
  CONCLUSIONS
  In patients with stable CIHD and histories of nonsevere hypersensitivity reactions to ASA/NSAIDs, an ASA challenge is advisable. Patients with an ACS and histories of hypersensitivity reactions to ASA, especially following doses lower than 100 mg, should directly undergo desensitization.
authors.affiliation: Internal Medicine and Rheumatology Department, Azienda Sanitaria Romagna, Rimini Hospital, Rimini, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Cortellini
authors.affiliation: Allergy Unit, Complesso Integrato Columbus, Rome, Italy.|IRCCS Oasi Maria S.S., Troina, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Romano
authors.affiliation: Internal Medicine and Rheumatology Department, Azienda Sanitaria Romagna, Rimini Hospital, Rimini, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Santucci
authors.affiliation: Department of Dermatology and Allergology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
authors.forename: A
authors.initials: A
authors.lastname: Barbaud
authors.affiliation: Department of Clinical Immunology and Allergy, School of Medicine, Ankara University, Ankara, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Bavbek
authors.affiliation: Allergy Unit, San Martino Hospital, Genoa, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Bignardi
authors.affiliation: Allergy Service, Carlos Haya Hospital, Malaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Blanca
authors.affiliation: Allergy Unit, University Hospital of Verona, Verona, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bonadonna
authors.affiliation: Allergy Unit, Poma Hospital, Mantua, Italy.
authors.forename: M T
authors.initials: MT
authors.lastname: Costantino
authors.affiliation: Allergy Unit, Hospital de la Cruz Roja, Madrid, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: Laguna
authors.affiliation: Allergy Unit, University Hospital of Verona, Verona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Lombardo
authors.affiliation: Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: L M
authors.initials: LM
authors.lastname: Losappio
authors.affiliation: Department of Rheumatology, Medical University of Lodz, Lodz, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Makowska
authors.affiliation: Allergy and Immunology, Clinic Royal Liverpool and Broadgreen University Hospital, Liverpool, UK.
authors.forename: A
authors.initials: A
authors.lastname: Nakonechna
authors.affiliation: Allergy Unit, Internal Medicine Department, Azienda Sanitaria Romagna, Faenza, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Quercia
authors.affiliation: Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: E A
authors.initials: EA
authors.lastname: Pastorello
authors.affiliation: Allergy Unit, Santa Maria della Speranza Hospital, Battipaglia, Italy.|Azienda Sanitaria Locale Salerno, Salerno, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Patella
authors.affiliation: Academisch Medisch Centrum, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Terreehorst
authors.affiliation: Allergy and Clinical Immunology Unit, Azienda Sanitaria di Firenze, San Giovanni di Dio Hospital, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Testi
authors.affiliation: Immunoallergy Department, Centro Hospitalar Sao Joao, Porto, Portugal.
authors.forename: J R
authors.initials: JR
authors.lastname: Cernadas
authors.affiliation: Allergy Unit, Hospital de la Cruz Roja, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Dionicio Elera
authors.affiliation: Internal Medicine and Rheumatology Department, Azienda Sanitaria Romagna, Rimini Hospital, Rimini, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Lippolis
authors.affiliation: Allergy Unit, San Martino Hospital, Genoa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Voltolini
authors.affiliation: Cardiology Unit, Azienda Sanitaria Romagna, Rimini Hospital, Rimini, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Grosseto
mesh_terms: D000368:Aged; D000465:Algorithms; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D000066491:Clinical Decision-Making; D015897:Comorbidity; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods; D004342:Drug Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
keywords: aspirin; challenge procedure; desensitization procedure; nonsteroidal anti-inflammatory drugs hypersensitivity