Aspirin Desensitization: Implications for Acetylsalicylic Acid-Sensitive Pregnant Women

Abstract

Low-dose acetylsalicylic acid (ASA) is widely used during pregnancy to prevent obstetric complications of placental dysfunction, such as preeclampsia, stillbirth and fetal growth restriction, and obstetric complications in pregnant women with antiphospholipid syndrome. ASA-sensitive pregnant women cannot benefit from the effects of ASA due to the possibility of severe or potentially life-threatening hypersensitivity reactions to ASA. ASA desensitization is a valuable and safe therapeutic option for these women, allowing them to start daily prophylaxis with ASA and prevent pregnancy complications. The authors discuss the recent advances in obstetric conditions preventable by ASA and the management of ASA hypersensitivity in pregnancy, including ASA desensitization. To encourage the implementation of ASA desensitization protocols in ASA-sensitive pregnant women, they also propose a practical approach for use in daily clinical practice.

Acetylsalicylic acid desensitization in an allergic pregnant woman post-vascular scaffolds implantation

“…(11) Since an ASA challenge was not performed before pregnancy, desensitization has been carried out in a multidisciplinary setting with access to resuscitation facilities and an intensive care unit for maternal and foetal monitoring. (4) Even if desensitization procedures could be at risk during pregnancy, this case shows that, in a patient with a history of mild reaction to ASA, a desensitization protocol during M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n pregnancy may be safe and effective in a tertiary centre with a multidisciplinary team, thus making it a valuable option, when the drug is mandatory for the patient. Nonetheless, given the lack of international standardization protocols and limited published data available, more studies are necessary to establish the risks and benefits for ASAdesensitization protocols in ASA-sensitive pregnant women.…”

“…(3) In Literature only four cases on ASA desensitization during pregnancy have been published, especially in women diagnosed with antiphospholipid syndrome. (4) Since there are no commercially available tests to detect NSAIDs hypersensitivity, a diagnostic strategy successfully used for decades is to challenge patients with past mild reactions to NSAIDs. However, ASA desensitization protocol is mandatory in case of positive challenge, or for safety reasons in history of severe reaction, or unstable pathology with compelling need for aspirin.…”

Prevención de la preeclampsia. Desde la dieta hasta la aspirina: revisión de la literatura

“…Las contraindicaciones para el uso de aspirina son la historia de alergia o hipersensibilidad a la aspirina, a otros salicilatos o a otros antiinflamatorios no esteroideos, por el riesgo de sensibilidad cruzada, pero se proponen protocolos de desensibilización al ácido acetilsalicílico en estas mujeres 36 . Otras contraindicaciones son pólipos nasales, asma y antecedente de broncoespasmo inducido por aspirina 36 .…”

“…Las contraindicaciones para el uso de aspirina son la historia de alergia o hipersensibilidad a la aspirina, a otros salicilatos o a otros antiinflamatorios no esteroideos, por el riesgo de sensibilidad cruzada, pero se proponen protocolos de desensibilización al ácido acetilsalicílico en estas mujeres 36 . Otras contraindicaciones son pólipos nasales, asma y antecedente de broncoespasmo inducido por aspirina 36 . Dentro de las contraindicaciones relativas se incluyen la historia de sangrado gastrointestinal o de úlcera péptica activa, otras fuentes de sangrado gastrointestinal o genitourinario, y disfunción hepática grave 27 .…”