Hypersensitivity to aspirin

The NSAIDs are contraindicated in patients with known hypersensitivity. There is a cross-sensitivity to other NSAIDs. Therefore, if a patient is allergic to one NSAID, there is an increased risk of an allergic reaction with any other NSAID. Hypersensitivity to aspirin is a contraindication for all NSAIDs. In general, the NSAIDs are contraindicated during the third trimester of pregnancy and during lactation. 

Szczeklik A, Nizankowska-Mogilnicka E, Sanak M Hypersensitivity to aspirin and nonsteroidal antiinflammatory drugs in Adkinson NF, Busse WW, 19 Bochner BS, et al (eds) Middleton s Allergy, ed 7. St Louis, Mosby Elsevier, 2009, pp 1227-1243. 

Zembowicz A, Mastalerz L, Setkowicz M, Radzis-zewski W, Szczeklik A Histological spectrum of cutaneous reactions to aspirin in chronic idiopathic urticaria. J Cutan Pathol 2004 31 323-329. Mastalerz L, Setkowicz M, Sanak M, Szczeklik A Hypersensitivity to aspirin common eicosanoid alterations in urticaria and asthma. J Allergy Clin Immunol 2004 113 771-775. 

SODiUM SALiCYLATE Less effective than an equal dose of aspirin in reducing pain or fever. Patients hypersensitive to aspirin may be able to tolerate sodium salicylate. Each gram contains 6.25 mEq sodium. 

Some patients exhibit hypersensitivity to aspirin in the form of salicylism, which is accompanied by ringing in the ears (tinnitus), vertigo, and bronchospasm (especially in asthmatics). The use of salicylate-containing preparations is not the only source of this drug. Those sensitive to salicylates should be aware of salicylates in a number of foods, such as curry powder, licorice, prunes, raisins, and paprika. 

Contraindications Hypersensitivity to aspirin, diclofenac, and other NSAlDs porphy-... 

Contraindications Active G1 bleeding, factor Vll or factor IX deficiencies, hypersensitivity to aspirin or NSAlDs... 

Contraindications Active peptic ulcer disease, chronic inflammation of GI tract, GI bleeding or ulceration, history of hypersensitivity to aspirin or NSAIDs... 

Contraindications Active GI bleeding or ulcerations hypersensitivity to aspirin, indomethacin, or other NSAIDs renal impairment, thrombocytopenia... 

Contraindications Severely incapacitated, bedridden, wheelchair bound, hypersensitivity to aspirin or other NSAIDs... 

History of hypersensitivity to aspirin or another NSAID, severe heart failure, patients with previous or active peptic ulceration... 

Diclofenac is contraindicated in those with a history of hypersensitivity to aspirin or another NSAID, severe heart failure, patients with previous or active peptic ulceration, or porphyria. It should be avoided in pregnancy. It should be used with caution in patients with allergic disorders, renal, hepatic and cardiac impairment, the elderly, in lactation and in those with coagulation defects. 

Although the overall incidence of sensitivity to FDScC yellow 5 (tartrazine) in the general population is low, it is frequently seen in patients who are also hypersensitive to aspirin. 

Do not give if there is a history of active peptic ulcer, other GI ulceration, chronic inflammation of the GI tract, GI bleeding disorders, or a history of hypersensitivity to aspirin and other NSAIDs. Use caution with patients who have kidney, liver, GI tract disease, or a history of fluid retention. 

Buclizine contains tartrazine, which may cause allergic reactions including asthma in susceptible individuals who also exhibit hypersensitivity to aspirin. 

Salsalate is contraindicated in patients with known hypersensitivity to aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) and in the presence of gastrointestinal (GI) ulcer or GI bleeding because the drug may irritate the GI tract. It should be used cautiously in patients with hypothrombinemia, vitamin K deficiency, and bleeding disorders because of the potential for bleeding problems. 

Certain individuals display hypersensitivity to aspirin and NSAIDs, as manifested by symptoms that range from vasomotor rhinitis with profuse watery secretions, angioedema, generalized urticaria, and bronchial asthma to laryngeal edema, bronchoconstriction, flushing, hypotension, and shock. Aspirin intolerance is a contraindication to therapy with any other NSAID because cross-sensitivity can provoke a life-threatening reaction. 

The choice among tNSAIDs for the treatment of chronic arthritic conditions such as rheumatoid arthritis largely is empirical. Substantial differences in response have been noted among individuals treated with the same tNSAID and within an individual treated with different tNSAIDs. It is reasonable to give a drug for two weeks as a therapeutic trial and to continue it if the response is satisfactory. Initially, all patients should be asked about previous hypersensitivity to aspirin or any member of the NSAID class. Thereafter, low doses of the chosen agent should be prescribed to determine initial patient tolerance. Doses then may be adjusted to maximize efficacy or minimize adverse effects. 

About 10% of asthmatics are hypersensitive to aspirin, and in some individuals life-threatening bronchoconstriction can occur. This is not a drug-drug interaction but an adverse response of asthmatic patients to aspirin, whether taking an anti-asthmatic drug or not. The reasons are not fully understood. Those known to be sensitive to aspirin may also possibly react to other NSAIDs, in particular the acetylated salicylates, the indole and indene acetic acids, and the propionic acid derivatives (see Table 6.1 , (p.l34)). The fenamates, oxicams, pyrazolones and pyrazolidinediones are better tolerated. The nonacetylated salicylates (sodium salicylate, salicylamide, choline magnesium trisalicylate) are normally well tolerated. Aspirin-sensitive individuals are also less likely to react to nimesulide. ... 

Giraldo B, Blumenthal MN, Spink WW (1969) Aspirin intolerance and asthma. A clinical and immunological study. Ann Intern Med 71 479-496 Girard JP, Hildebrandt F, Favre H (1969) Hypersensitivity to aspirin clinical and immunological studies. Helv Med Acta 35 8 95... 

Tartrazine is most likely to produce urticaria in patients with allergic hypersensitivity to aspirin and the salicylate drugs (Ros et al. 1976). It is, therefore, prudent to administer white antihistamines, free of dyes, to such aspirin-sensitive individuals. (The presence of color in a tablet or capsule does not necessarily imply that the F.D. and C. Yellow No. 5 is necessarily used in its manufacture, however, a white antihistamine is free of all dyes.) The antihistamines shown in Table 2 are free of all dyes. 

Ros A, Juhlin L, Michaelsson G (1976) A follow up study of patients with recurrent urticaria and hypersensitivity to aspirin benzoates and azo dye. Br J Dermatol 95 19-24 Schreiber MM, Naylor LZ (1962) Antihistamine photosensitivity. Arch Dermatol 86 58-62 Sidi E, Hincky M, Gervais M (1955) Allergic sensitization and photosensitization to phener-gan cream. J Invest Dermatol 24 345-352... 

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