Prevalence and management of aspirin hypersensitivity in a cardiology practice

Abstract

Background: Data are lacking with concern to the prevalence and management of aspirin (ASA) hypersensitivity. Objective: To study the prevalence, different types of reactions, and implications for clinical management of ASA hypersensitivity in a cardiology practice. Methods: We conducted an electronic medical record review of 11,375 individuals, 5052 (44%) in the ambulatory setting, and 6323 (56%) admitted for percutaneous coronary intervention (PCI), from January 2012 to December 2013. Results: The prevalence of ASA hypersensitivity was 1.88% (n = 214). Skin reactions were the most common (40 [19%]), followed by angioedema (10 [4.6%]), respiratory (9 [4.2%]), and anaphylaxis (6 [2.8%]). No records were found for 74 patients (34.5%), and 69 patients (32.2%) were mistakenly labeled as allergic for having gastrointestinal symptoms. Of the 214 patients who had documented ASA hypersensitivity, 108 individuals (50.46%) had coronary artery disease. The medications at discharge were the following: ASA (30 [14%]), thienopyridine (48 [22%]), a combination of ASA and thienopyridine (13 [6%]), anticoagulation only (26 [12%]), and no antiplatelet (97 [43%]). Conclusion: ASA hypersensitivity is often not documented correctly or is often misdiagnosed or not appropriately managed. There is a need for improved management of ASA hypersensitivity, including appropriate referral for ASA desensitization and combating unnecessary avoidance in patients with intolerance due to adverse effects.

Hypersensitivity reactions to non‐steroidal anti‐inflammatory drugs (NSAIDs) – a retrospective study

“…With a prevalence of 12.8 %, cardiovascular disease is a common illness in Germany [24]. On the one hand it is important to determine a patient's threshold dose for combating unnecessary avoidance, on the other hand it is necessary identifying patients with hypersensitivity reactions to ASA at low doses (< 100 mg) with medical need for ASA desensi-tization [25][26][27]. OPT with increasing doses under medical surveillance is a highly target-oriented tool to identify safe low-dose treatment options even in the case of suspected ASA hypersensitivity.…”

Cilostazol combined with P2Y12 receptor inhibitors: A substitute antiplatelet regimen for aspirin‐intolerant patients undergoing percutaneous coronary stent implantation

“…It is often mislabeled as “aspirin hypersensitivity” or “aspirin resistance”. 28 , 29 Dai defined “aspirin intolerance” as “any conditions that prevent patients from long‐term use of low‐dose aspirin”, 13 while earlier researchers conflated it with aspirin‐exacerbated respiratory disease. 28 We summarized a clinical criterion of aspirin intolerance based on our previous cross‐sectional study and related published studies, which became the theoretical origin of inclusion criteria.…”

“… 28 , 29 Dai defined “aspirin intolerance” as “any conditions that prevent patients from long‐term use of low‐dose aspirin”, 13 while earlier researchers conflated it with aspirin‐exacerbated respiratory disease. 28 We summarized a clinical criterion of aspirin intolerance based on our previous cross‐sectional study and related published studies, which became the theoretical origin of inclusion criteria. Seven clinical criteria mainly covered gastrointestinal contraindications, hyperuricemia, and hypersensitivity (both respiratory and mucocutaneous).…”

“…The concept of “Aspirin intolerance” has not been universally acknowledged before. It is often mislabeled as “aspirin hypersensitivity” or “aspirin resistance” 28,29 . Dai defined “aspirin intolerance” as “any conditions that prevent patients from long‐term use of low‐dose aspirin”, 13 while earlier researchers conflated it with aspirin‐exacerbated respiratory disease 28 .…”

Überempfindlichkeitsreaktionen auf nichtsteroidale Antiphlogistika (NSAID) – eine retrospektive Studie

“…Andererseits muss man diejenigen Patienten identifizieren, die bereits bei niedrigen Dosierungen von ASS (< 100 mg) überempfindlich reagieren. Bei diesen besteht eine medizinische Indikation zur Desensibilisierung gegenüber ASS [25][26][27]. Ein OPT mit ansteigenden Dosierungen unter medizinischer Überwachung ist eine zielführende und praxisorientierte Maßnahme, um sichere und niedrig dosierte Behandlungsoptionen auch bei vermuteter Überempfindlichkeit auf ASS zu identifizieren.…”