SELECTED ARTICLES FROM THE RECENT LITERATURE 2007

August 20, 2007

Management options for aspirin/NSAID sensitivity

Summary
Background - Non-selective sensitivity to aspirin (ASA) and NSAID drugs can cause prominent reactions in the upper and lower respiratory tracts (AERD) and dermatologic reactions. These non-selective reactions to ASA and a variet of NSAID are thought to be related to the inhibition of the COX-1 enzyme system by the suspect drugs.

Findings - The therapeutic approaches to avoiding adverse reactions to ASA/NSAID in sensitive subjects were reviewed by Knowles et al of the Sunnybrook Health Sciences Center in Toronto, Canada. Based on a literature review they concluded that: 1) Avoidance of ASA/NSAID should be the primary approach whenever feasible; 2) when ASA is strongly indicated for thromboembolic prophylaxis, ASA desensitization under careful observation followed by maintenance daily ASA dosing is indicated; 3) use of COX-2 selective inhibitors in these ASA/NSAID sensitive patients, does not trigger respiratory reactions but may trigger a rash in those with histories of ASA/NSAID-induced dermatologic reactions; 4) acetaminophen can be used in doses less than 1000 mg in ASA/NSAID sensitive patients; 5) the role of leukotriene modifiers (e.g. montelukast) in preventing ASA-induced asthma requires further investigation.

Reference
Ann Pharmacother 2007;41:1191-1200

Editor's Comments
These comments are in line with what I have read. The alternative of using COX-2 selective inhibitors for anti-inflammatory treatment of ASA/NSAID sensitive patients is limited considerably by recent concerns about the potential for increased cardiac problems in chronic users of such COX-2 selective inhibitors.

 

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