Aspirin allergic drug reactions

Fig. 2.2 An example of generalized urticaria (hives) showing smooth, erythematous, and pruritic confluent papules and plaques. Aspirin and other nonsteroidal rmti-inflammatory drugs are a frequent cause of hives but virtually any drug can precipitate the condition. From Anderson J, Lieberman P, Blaiss M. Allergic drug reactions. Atlas of allergic diseases 2002 IS 26. With kind permission from Springer Science-tBusiness Media B.V...

It was the progenitor drug aspirin that was the first NSAID implicated in an allergic-Uke reaction when, in 1902, Hirschberg reported acute... 

Aspirin and NSAIDs can induce allergic and pseudoallergic reactions. Because these drugs are used so widely, with much over-the-counter use, the health care professional must have a basic understanding of the types of reactions that can occur and how to prevent them. Three types of reactions occur bron-chospasm with rhinoconjunctivitis, urticaria/angioedema, and anaphylaxis. Remember that patients with gastric discomfort... 

CS, a 55-year-old woman, is admitted to the hospital with an intraabdominal infection. During the patient interview, CS states that she is allergic to aspirin, codeine, sulfa drugs, penicillin, levofloxacin, and vancomycin. The reactions are described as follows ... 

Type B effects are not related to the pharmacological properties of these drugs. Serious side effects may occur. Allergic skin and liver reactions to aspirin and paracetamol have been reported with risk of fibrosis, particularly in the retroperitoneal region for methysergide and hypersensitivity reactions with NSAID and pure analgesics. 

Hypersensitivity reactions to aspirin are much more likely to occur in patients with asthma or allergic problems than in the normal population. One in 10 patients with asthma may be hypersensitive and suffer severe bronchospasm. Other reactions are urticaria, angioedema and rhinitis. The incidence of hypersensitivity to ibuprofen is much lower than with aspirin, but the drug should be avoided by patients with asthma and individuals who are sensitive to aspirin, unless they have taken ibuprofen before without problems. 

Asthmatic attacks due to non-narcotic analgesics, mostly occur in patients with so-called intrinsic or idiosyncratic asthma (often associated with nasal polyposis, sinusitis and eosinophilia of the blood) (McFadden and Austen 1977). About 10% of patients with this kind of asthma show severe reactions to aspirin, methyl-salicylate, pyrazolone derivatives, indomethacin, ibuprofen, diclofenac and sometimes even phenacetin and paracetamol. (Sodium salicylate is often tolerated.) The special reactivity may appear only in later life and concerns a number of chemically unrelated drugs. In some of these patients analgesic therapy with a morphine derivative such as pentazocine (Fortalgesic) or hyoscine butylbromide (Buscopan) may be necessary. However, in other patients, those with aspirin urticaria rather than asthma, the reaction may also rely on a drug-specific allergic mechanism (de Weck 1971). 

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