Aspirin/NSAID Sensitivity
By Brian A. Smart, MD, FAAAAI
Allergists
frequently see patients who are sensitive to aspirin and non-steroidal
anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen and
ketoprofen. Aspirin and NSAIDs all block an enzyme called
cyclooxygenase-1 (COX-1). Therefore, if you have a reaction to aspirin
or any NSAID, you are at risk to be sensitive to all the other members
of the group.
Most reactions to these medications fall into two groups: symptoms in
both the upper and lower airway, such as wheeze, cough, shortness of
breath, and runny nose and skin symptoms, such as urticaria (hives) and
angioedema (swelling). It is important to be evaluated if you think you
may be sensitive to aspirin and NSAIDs.
A very dangerous reaction to aspirin/NSAIDs is worsening of asthma, with
such symptoms as wheezing, cough, and shortness of breath. In fact, at
least 10% of people over age 10 who have asthma will experience
worsening of their asthma if they take aspirin/NSAIDs.
Since roughly one third of people who have asthma do not know they have
this condition, it is important that you avoid aspirin/NSAIDs if you
experience wheezing, cough, or shortness of breath with these
medications. If you experience these symptoms with aspirin/NSAIDs, you
should be evaluated both for sensitivity to these medications and for
possible asthma.
Many people who are sensitive to aspirin/NSAIDs experience nasal
symptoms, such as runny nose, post-nasal drip, and congestion. These
upper airway reactions are closely related to the lower airway reactions
of wheezing, cough and shortness of breath. In fact, these symptoms,
along with nasal/sinus polyps, are found together in a syndrome called
“Samter’s Triad.” If you have nasal symptoms with aspirin/NSAIDs or have
nasal/sinus polyps, you should discuss this with your physician, because
you may have asthma symptoms that you have not noticed.
20% to 80% of people who have chronic urticaria and angioedema (hives
and swelling) will experience worsening of the urticaria and angioedema
if they take aspirin/NSAIDs. If you have chronic urticaria and
angioedema, it is best to avoid aspirin/NSAIDs.
It is uncomfortable to have urticaria and angioedema, but there may
also be risks to your safety, such as swelling of the upper airway, if
you are not careful to avoid triggers of this condition. If you notice
that you get urticaria and angioedema after taking aspirin/NSAIDs, you
should avoid these medications and be evaluated by a physician.
The first line of management of aspirin/NSAIDs is to avoid them. Most
experts suggest that acetaminophen in doses up to 1000 mg is safe for
people with aspirin/NSAID allergy. There is also a new class of pain and
inflammation medication called “COX-2 inhibitors” that appears to
generally be safe for people with aspirin/NSAID allergy. If you need to
take aspirin/NSAIDs, a visit to an allergist/immunologist can be very
helpful.
Allergist/immunologists have special training in the evaluation and
treatment of sensitivity to aspirin/NSAIDs. If it is indicated, an
allergist/immunologist can do testing for aspirin/NSAID allergy. If
necessary, such as in the situation of coronary artery disease (which
may require the long-term use of low-dose aspirin), or uncontrollable
nasal/sinus polyps, an allergist/immunologist may be able to desensitize
individuals to aspirin/NSAIDs. Unfortunately, it is not possible to
desensitize people who have chronic urticaria and angioedema to aspirin/NSAIDs.
Sensitivity to aspirin/NSAIDs is common and potentially dangerous. It is
important to know if you are sensitive to these medications. Some clues
include wheeze, cough, shortness of breath, runny nose, congestion,
hives and swelling after taking these medications. If you have any of
these symptoms after taking aspirin/NSAIDs, avoid these medications and
see a physician. Allergist/immunologist have special training in the
evaluation and treatment of aspirin/NSAID sensitivity.
