We all know someone who is “allergic” to a medication. Many times that person is not having a
true allergic reaction but either a side effect to the drug or just an adverse reaction. This is also the
case with aspirin or the related non-steroidal anti-inflammatory drugs (NSAlDS) such as ibuprofen
There is a special group of individuals that have a unique reaction to aspirin and the NSAlDS. These are a subset of asthmatics. Twenty percent of asthmatics are sensitive to aspirin and NSAIDS. This group of asthmatics have what is called Aspirin Exacerbated Respiratory Disease (AERD). It was originally known as Samter’s Syndrome or Triad Asthma. AERD is a combination of asthma, chronic sinusitis. nasal polyps and then a reaction to aspirin or an NSAlD, This reaction is not a true allergic reaction but an exaggerated response of the body to the biological effect of aspirin or all NSAIDS. This reaction is characterized by watery itchy eyes. runny nose. nasal congestion, sinus-like headache and a severe exacerbation of asthma. An aspirin reaction occurs between twenty minutes and three hours after ingesting the aspirin or NSAlD.
Aspirin-sensitive asthma or AERD occurs in approximately 20 percent of asthmatics. It signifies an aggressive form of inflammatory airways disease mediated by inflammatory chemicals called leukotrienes. Avoiding aspirin or any of the NSAIOS actually does not help the disease. Unfortunately there are many asthmatics avoiding these drugs simply because they have asthma and there is the misconception that all asthmatics may be sensitive to aspirin. By unnecessarily avoiding aspirin or NSAIDS. these patients do not have appropriate medications for pain control, arthritis, and fever reduction or cardio prophylaxis utilizing low dose aspirin.
So, if I am an asthmatic, how can I tell if I have this type of asthma?
Well, it is not as hard as you may think. We first look at the patient’s medical history, The patient must have asthma, chronic sinusitis and nasal polyps. Typically patients describe the onset of their disease as a “cold that never, went away.” Then there must be a history of reacting to aspirin or any of the NSAIDS if all these events are present, it then requires an oral challenge to aspirin to prove if the patient is truly aspirin sensitive. These challenges were formalized at Scripps Clinic and Research Foundation in La Jolla. California, Initially the challenge required a week long hospitalization, The Allergy department at Scripps Clinic has refined the process for the outpatient setting. The safety of the aspirin challenge has also been improved with the development of anti leukotriene medications. After undergoing an aspirin challenge. the patient can be desensitized and take aspirin or an NSAID for an appropriate medical condition. The patient can also be desensitized and take aspirin daily to actually help treat the asthma and sinus disease.
With all this information. who should think about undergoing an aspirin challenge? Asthmatic patients with the appropriate history who need to take aspirin every day for cardiac reasons or those patients that need an anti-inflammatory medication for arthritis or similar condition, Also. those asthmatics with poorly controlled asthma or who have required multiple sinus surgeries to control the sinus disease or polyp formation are excellent candidates for aspirin desensitization.
Having trained at Scripps Clinic. I have been involved in many aspirin challenges and desensitizations, The process of aspirin desensitization is safe under the appropriate supervision and now available in the outpatient setting. Most desensitizations take a minimum of two days to complete.
If you think you or a loved one may be a candidate for this procedure. please feel free to contact our office at 480-949-7377. We would be happy to talk with you to help determine if aspirin desensitization on may be right for you.