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Guidance for Coronary Patients With ASA/NSAID Sensitivity

Challenge, desensitization recommended in stable patients with reaction history


MONDAY, Oct. 24, 2016 (HealthDay News) -- In patients with stable chronic ischemic heart disease (CIHD) and histories of nonsevere hypersensitivity reactions to acetylsalicylic acid (ASA)/nonsteroidal anti-inflammatory drugs (NSAIDs), an ASA challenge is recommended, according to a study published online Oct. 12 in Allergy.

Gabriele Cortellini, M.D., from Rimini Hospital in Italy, and colleagues analyzed data on ASA challenges and desensitizations from 10 allergy centers (310 patients) and sought consensus from physicians and an expert panel to determine clinical criteria for eligibility for an ASA challenge and/or desensitization in coronary artery disease patients with hypersensitivity to ASA.

The researchers found that 119 of the 310 subjects had index reactions to ASA doses lower than 300 mg. Of the 138 with acute coronary syndrome (ACS), 101 underwent desensitizations. Of the 172 with CIHD, 126 underwent challenges. In all, 163 subjects underwent challenges and 147 underwent desensitizations; in the latter group, 86 had index reactions to ASA doses of 300 mg or less. Ten subjects reacted to challenges (seven at doses ≤500 mg; three at a cumulative dose of 110 mg). The desensitization failure rate was 1.4 percent.

"In patients with stable CIHD and histories of non-severe hypersensitivity reactions to ASA/NSAIDs, an ASA challenge is advisable," the authors write. "Patients with an ACS and histories of hypersensitivity reactions to ASA, especially following doses lower than 100 mg, should directly undergo desensitization."

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