Aspirin Sensitivity: The Role for Aspirin Challenge and Desensitization in Postmyocardial Infarction Patients

Schaefer, Oren P.; Gore, Joel M.

doi:10.1159/000006871

Cited by 30 publications

(24 citation statements)

References 23 publications

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“…Therefore, it is believed that the genetic basis of aspirin hypersensitivity differs in different ethnic groups, and the response to aspirin desensitisation in different ethnicities may be variable. Although the success of aspirin desensitisation has been demonstrated in several studies, [22][23][24][25][26][27] to our knowledge this issue has not been addressed in the Chinese. In this study, we investigated the efficacy and safety of aspirin desensitisation in a cohort of Chinese patients who suffered from aspirin hypersensitivity and CAD, for whom cardiac catheterization and PCI were indicated.…”

Section: 為冠狀動脈病華籍患者進行阿司匹林脫敏療法mentioning

confidence: 99%

“…[22][23][24][25][26][27] In aspirin-intolerant patients suffering from severe rhinosinusitis and nasal polyps, aspirin desensitisation has even been used as a therapeutic measure to ameliorate the nasal symptoms. Different aspirin desensitisation protocols have been developed and yield promising results.…”

Section: /F Aspirin and Diclofenac-induced Rashmentioning

confidence: 99%

“…The traditional desensitisation protocols adopt long intervals of up to 24 hours between aspirin doses and take several days to complete. [22][23][24][25] The latter approach is theoretically safer as early signs of anaphylaxis can be picked up during the long observation intervals between drug challenges. Protocols for rapid desensitisation involving shorter intervals between drug doses evolved subsequently and have been shown to be effective and safe.…”

Section: /F Aspirin and Diclofenac-induced Rashmentioning

confidence: 99%

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Aspirin desensitisation for Chinese patients with coronary artery disease

Lee¹,

Tsui²,

Cheung³

et al. 2013

Hong Kong Med J

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Objective To assess the efficacy and safety of aspirin desensitisation in Chinese patients with coronary artery disease. Design Case series.Setting A regional hospital in Hong Kong.Patients Chinese patients with coronary artery disease and a history of a hypersensitivity reaction to aspirin or non-steroidal antiinflammatory drug, who underwent aspirin desensitisation between February 2008 and July 2012.Results There were 24 Chinese patients with coronary artery disease who were admitted to our unit for aspirin desensitisation during this period. The majority (79%) were clinical admissions for desensitisation; eight (33%) of them developed a hypersensitivity reaction during desensitisation. Half of the latter had only limited cutaneous reactions and were able to complete the desensitisation protocol and developed aspirin tolerance. Overall, 20 (83%) of the patients were successfully desensitised at the initial attempt.No serious adverse reactions occurred in the cohort. Twelve of the patients had significant coronary artery disease revealed by coronary angiography and received a percutaneous coronary intervention, nine of whom received drug-eluting stents while three received bare metal stents due to financial constraints. All 11 successfully desensitised patients received aspirin and clopidogrel as double antiplatelet therapy after percutaneous coronary intervention. The remaining patient had a bare metal stent implant due to failed aspirin desensitisation. ConclusionGiven the potentially different genetic basis of aspirin hypersensitivity in different ethnicities, recourse to desensitisation in the Chinese population has not previously been addressed. This study demonstrated that aspirin desensitisation using a rapid protocol can be performed effectively and safely in Chinese patients. Our results were comparable to those in other reported studies involving other ethnicities. Successful aspirin desensitisation permits patients to pursue long-term double antiplatelet therapy that includes aspirin after percutaneous coronary intervention, and thus allows the use of drug-eluting stents as a feasible option.

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Section: 為冠狀動脈病華籍患者進行阿司匹林脫敏療法mentioning

confidence: 99%

Section: /F Aspirin and Diclofenac-induced Rashmentioning

confidence: 99%

Section: /F Aspirin and Diclofenac-induced Rashmentioning

confidence: 99%

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Aspirin desensitisation for Chinese patients with coronary artery disease

Lee¹,

Tsui²,

Cheung³

et al. 2013

Hong Kong Med J

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“…Patients are more likely to react to aspirin when urticaria is active. 21--30% of those with chronic idiopathic urticaria will experience heightened urticaria when exposed to aspirin [8][9][10]. Patients with a specific diagnosis of chronic idiopathic urticaria are not thought to be appropriate for desensitisation, however, patients with urticaria as part of a cutaneous reaction may be considered for desensitization [10].…”

Section: Aspirin Allergymentioning

confidence: 99%

“…There are several published protocols which have established safe procedures to desensitize patients with known aspirin allergy [9,13,14], but no single guideline has been internationally adopted (Table 1). In principle, a patient is 'challenged' with incremental dose increases over fixed time periods, until a positive reaction to aspirin is noted, characterized typically by a reduction in FEV1 of > 20%, combined with naso-ocular symptoms [13].…”

Section: Aspirin Desensitizationmentioning

confidence: 99%

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

Chapman

Rushworth²,

Leslie³

2013

Cardiol J.

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Aspirin Sensitivity

Gollapudi¹,

Teirstein²,

Stevenson³

et al. 2004

JAMA

147

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Context 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). Evidence AcquisitionPublished 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. Evidence SynthesisThe 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.Abbreviation: NSAIDs, nonsteroidal anti-inflammatory drugs. *Type II reactions are unable to undergo effective acetylsalicylic acid desensitization therapy.†Patients with type I, III, IV, and V reactions receive a double dose on the advance dosing schedule. ‡Avoid the suspected NSAID and challenge with another NSAID or acetylsalicylic acid to prove drug tolerance. §Patients did not have underlying risk factors for NSAID adverse reactions (ie, asthma, chronic idiopathic urticaria).Recent recommendations have argued against attempting desensitization therapy in patients with concomitant coronary artery disease and type V reactions. 17 ¶If challenging with the suspect drug, testing should be performed in an intensive care setting with intravenous access in place ...

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Aspirin Sensitivity: The Role for Aspirin Challenge and Desensitization in Postmyocardial Infarction Patients

Cited by 30 publications

References 23 publications

Aspirin desensitisation for Chinese patients with coronary artery disease

Aspirin desensitisation for Chinese patients with coronary artery disease

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

Aspirin Sensitivity

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