Aspirin Sensitivity

Aspirin and other NSAIDs (nonsteroidal anti-inflammatory drugs) are staples of many at-home medicine cabinets. These drugs alleviate pain, reduce inflammation, and bring down fevers in both children and adults. However, for some individuals, these otherwise useful medications can cause a wide range of adverse reactions. People who experience swelling, severe abdominal pain, or difficulty breathing after taking aspirin likely have aspirin sensitivity.

Symptoms of Aspirin Sensitivity

The symptoms of an aspirin sensitivity can range from mild to severe. Typically, reactions occur within the first hour of taking aspirin and include:

• Itching, hives, and/or rash
• Swelling and/or flushing
• Runny nose and/or nasal congestion
• Difficulty breathing, wheezing, and/or coughing
• Abdominal pain and/or nausea
• Anaphylaxis

Anaphylaxis is a life-threatening, though rare, allergic reaction that requires immediate medical attention. Characteristic symptoms of an anaphylactic reaction include severe difficulty breathing, swelling of the throat, bodily rash/itching, swelling, vomiting, abdominal pain, a drop in blood pressure, a rapid (though weak) pulse, dizziness, confusion, and/or loss of consciousness.

Those with aspirin sensitivity are also likely to have other chronic complications, such as asthma or recurrent nasal polyps. When patients who have aspirin sensitivity also have asthma and nasal polyps, this is called aspirin-exacerbated respiratory disease (AERD) or the Samter’s Triad. This is a chronic condition and primarily affects adults. Without management or treatment options, AERD can worsen over time. Loss of smell is common in patients with AERD.

Do not mistake the side effects of aspirin or other NSAIDs as aspirin sensitivity! Symptoms of aspirin sensitivity are those that do not include the side effects specifically listed on the drug-label for aspirin or any other NSAIDs.

Aspirin-Exacerbated Respiratory Disease

Aspirin-exacerbated respiratory disease (AERD), aspirin-sensitive asthma, or Samter’s Triad is a combination of chronic conditions that often develop in adulthood, typically during the 30s. This condition involves aspirin sensitivity in conjunction with chronic asthma and sinus congestion with recurrent nasal polyps. Without treatment, the situation can become more severe over time, leading to common issues such as loss of smell and frequent sinus infections.

Causes of Aspirin Sensitivity

Common NSAIDs that can cause the symptoms of aspirin sensitivity include:

• Aspirin (found in brand-names like Excedrin)
• Ibuprofen (found in brand-names like Advil or Motrin)
• Naproxen (found in brand-names like Aleve)
• Ketoprofen

Diagnosis and Treatment of Aspirin Sensitivity

At Frontier Allergy Asthma and Immunology, our allergy specialist has extensive training and experience diagnosing and treating aspirin sensitivity and AERD. Your initial consultation will typically start with a detailed discussion about your reaction history. Your allergist will inquire how many times exposure may have happened, what symptoms you may have had, how long did they last, if you required emergency medical treatment, etc. They will also ask about your allergies in general, medical history, and family history to get a full picture, which is especially important in the case of individuals who may have AERD. Your allergist will also perform a physical examination. If this information alone does not result in a clear answer, your physician may recommend an oral challenge test.

During an oral challenge test, small doses of aspirin will need to be taken orally in intervals over a period of time. You will be monitored closely by your physician and healthcare staff for possible adverse reactions to the consumption of aspirin. Because of this, an oral challenge test must be performed in the clinic with physician supervision. If you pass the oral challenge without any adverse reaction, your physician may be able to rule out an aspirin sensitivity. If you begin experiencing adverse symptoms during the oral challenge, the challenge will immediately stop and you will be positively diagnosed with aspirin sensitivity.

If you receive a diagnosis of aspirin sensitivity, your allergy specialist will work with you to create an individualized plan of care. This plan of care will involve measures to prevent symptoms through aspirin avoidance and to manage symptoms as they come.

Symptom management will likely include a prescription of self-injectable epinephrine to carry with you at all times in the event of an anaphylactic reaction. This is a life-saving medication that can help improve symptoms if you are on your own until emergency medical attention is available to treat you. It is important to seek emergency care even if you take your EpiPen in the event that your symptoms return.

Avoiding aspirin and other NSAIDs is imperative to managing and preventing symptoms of aspirin sensitivity. However, many of these drugs have unique benefits for pain relief and reducing inflammation, so your doctor may recommend undergoing aspirin desensitization. Aspirin desensitization involves initially taking low doses of aspirin and slowly increasing the dose until a therapeutic dose is adequately tolerated. This initial desensitization process must be performed in a healthcare setting with your allergist’s supervision. Once you have reached a therapeutic dose, you will take that dose of aspirin every day for the rest of your life. If you stop taking aspirin, you will have to repeat the desensitization process.

If you receive a diagnosis of AERD, your doctor will also recommend medications to better control your nasal and asthma symptoms. You may also need to consider nasal polyp removal with an otolaryngologist (ENT doctor). Aspirin desensitization can also help decrease the severity of your nasal and asthma symptoms.

FAQ

What is aspirin desensitization?

• Aspirin desensitization is a procedure that can make you tolerant to aspirin if you have Aspirin-Exacerbated Respiratory Disease (AERD). Even if you've had severe respiratory reactions to aspirin in the past, this procedure greatly reduces the risk of any reactions.
  
  The process involves gradually increasing the amount of aspirin you receive over a period of time. Your healthcare provider will start by giving you a small dose of aspirin and closely monitoring you for any reactions. As the dose increases, you'll continue to be observed until you reach the point where you would normally have an allergic reaction. However, you'll keep receiving the aspirin until you become tolerant to it without any adverse reactions. Aspirin desensitization is typically administered over several days.

What are the benefits of aspirin desensitization?

• Desensitization to aspirin comes with a few key benefits that include:
  • Relief from nasal/sinus and asthma symptoms
  • Reduced dependency on medication
  • Reduced need for professional help when it comes to asthma
  • Reduced surgical needs for sinus cases

Next steps

If you are interested in further discussion about your specific needs, Dr. Reshamwala is happy to see you and answer any questions you may have. Please call 512-382-1933 or email clinic@frontierallergist.com to schedule an appointment today! Book an appointment