Rapid Aspirin Challenge in Patients with Aspirin Allergy and Acute Coronary Syndromes

Amsterdam EA et al. 2014 ACC/AHA guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:2354–94. Wong JT, Nagy CS, Krinzman SJ, et al. Rapid oral challenge-desensitization for patients with aspirin-related urticaria-angioedema. J Allergy Clin Immunol. 2000;105:997–1001. De Luca G, Verdoia M, Binda G, et al. Aspirin desensitization in patients undergoing planned or urgent coronary stent implantation. A single-center experience. Int J Cardiol. 2013;167(2):561–3. McMullan KL, Wedner HJ. Safety of aspirin desensitization in patients with reported aspirin allergy and cardiovascular disease. Clin Cardiol. 2013;36:25–30. Rossini R, Angiolillo DJ, Musumeci G, et al. Aspirin desensitization in patients undergoing percutaneous coronary interventions with stent implantation. Am J Cardiol. 2008;101:786–9. Silberman S, Neukirch-Stoop C, Steg PG. Rapid desensitization procedure for patients with aspirin hypersensitivity undergoing coronary stenting. Am J Cardiol. 2005;95:509–10. Fajt ML, Petrov AA. Outpatient aspirin desensitization for patients with aspirin hypersensitivity and cardiac disease. Crit Pathw Cardiol. 2011;10:17–21. Cortellini G, Testi S, Severino M, et al. Aspirin challenge/desensitisation before coronary stenting in subjects with history of hypersensitivity. A pragmatic approach. Eur Ann Allergy Clin Immunol. 2012;44(4):160–2. Dalmau G, Gaig P, Gazquez V, Merce J. Rapid desensitization to acetylsalicylic acid in acute coronary syndrome patients with NSAID intolerance. Rev Esp Cardiol. 2009;62:224–5. Ortega-Loayza AG, Raza S, Minisi AJ, et al. Aspirin desensitization/challenge in 3 patients with unstable angina. Am J Med Sci. 2010;340:418–20. Christou A, Kafkas N, Marinakos A, et al. Rapid desensitisation of patients with aspirin allergy who undergo coronary angioplasty. Hell J Cardiol. 2011;52(4):307–10. Jenneck C, Juergens U, Buecheler M, Novak N. Pathogenesis, diagnosis, and treatment of aspirin intolerance. Ann Allergy Asthma Immunol. 2007;99:13e21. Feng CH, White AA, Stevenson DD. Characterization of aspirin allergies in patients with coronary artery disease. Ann Allergy Asthma Immunol. 2013;110(2):92–5. This article reviews 9,565 patients who were identified in a medical record with CAD and aspirin listed as an “allergy”. The article reports the nature of these reactions and also highlights the underutilization of aspirin challenge/desensitization. Meyboom RHB, Lindquist M, Egberts ACG. An ABC of drug related problems. Drug Saf. 2000;22:415–23. Gollapudi RR, Teirstein PS, Stevenson DD, Simon RA. Aspirin sensitivity: implications for patients with coronary artery disease. JAMA. 2004;292:3017e3023. Kowalski ML, Asero R, Bavbek S, et al. Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs. Allergy. 2013;68:1219–32. A comprehensive review describing the various hypersensitivity syndromes associated with aspirin and NSAIDs. Proposed diagnostic evaluation is also described. Rajan JP, Wineinger NE, Stevenson DD, White AA. Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: a meta-analysis of the literature. J Allergy Clin Immunol. 2015;135(3):676. Mastalerz L, Setkowicz M, Szczeklik A. Mechanism of chronic urticaria exacerbation by aspirin. Curr Allergy Asthma Rep. 2005;5(4):277–83. Woessner KM. Aspirin desensitization for cardiovascular disease. Curr Opin Allergy Clin Immunol. 2015;15(4):314–22. Katz Y, Goldberg N, Kivity S. Localized periorbital edema induced by aspirin. Allergy. 1993;48:366–9. Leeyaphan C, Kulthanan K, Jongjarearnprasert K, Dhana N. Drug-induced angioedema without urticaria: prevalence and clinical features. J Eur Acad Dermatol Venereol. 2010;24:685–91. Himly M, Jahn-Schmid B, Pittertschatscher K, Bohle B, Grubmayr K, Ferreira F, et al. IgE-mediated immediate-type hypersensitivity to the pyrazolone drug propyphenazone. J Allergy Clin Immunol. 2003;111:882–8. Phills J, Perelmutter L. IgE and non-IgE mediated allergic-type reactions to aspirin. Acta Allergol. 1974;29:474–9. Blanca M, Perez E, Garcia JJ, et al. Angioedema and IgE antibodies to aspirin: a case report. Ann Allergy. 1989;62:295–8. Aun MV, Blana M, Garro LS, et al. Nonsteroidal anti-inflammatory drugs are major causes of drug-induced anaphylaxis. J Allergy Clin Immunol. 2014;2:414–20. A review of anaphylaxis caused by medications. In this review NSAIDs are noted to be the most frequent cause of anaphylaxis in patients presenting to the emergency department with a drug reaction. The article also reports an underutilization of epinephrine in patients presenting with anaphylaxis. Ward KE, Archambault R, Mersfelder TL. Severe adverse skin reactions to nonsteroidal antiinflammatory drugs: a review of the literature. Am J Health Syst Pharm. 2010;67(3):206–13. Aseros R. Oral aspirin challenges in patients with a history of intolerance to single non-steroidal anti-inflammatory drugs. Clin Exp Allergy. 2005;35:713–6. The CURRENT–OASIS 7 Investigators. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med. 2010;363:10. Anderson JL, Adams CD, Antman EM. 2011 ACCF/AHA focused update on the management of patients with unstable angina/non-ST-elevation myocardial infarction. Circulation. 2011;123:2022–60. Kern M. Conversations in cardiology: what to do if your patient can’t take aspirin after stenting. Cath Lab Digest. 2014;22:10. Lee RU, Stevenson DD. Aspirin-exacerbated respiratory disease: evaluation and management. Allergy Asthma Immunol Res. 2011;3:3–10.