Allergy to aspirin what can i take
The main focus of treatment is the avoidance of any NSAID known or believed to cause allergy. This is especially true for persons with extreme hypersensitivity. This not only includes the avoidance of aspirin tablets and capsules but any product containing aspirin, including Alka Selzer, Vanquish, Pepto-Bismol, Kaopectate, Maalox, Doan’s, Sine-Off, and Pamprin.
By contrast, acetaminophen (Tylenol) is generally considered safe as are COX-2 inhibitors such as celecoxib (Celebrex).
Symptoms of an allergic reaction
Allergic reactions generally happen quickly within a few minutes of exposure to an allergen.
They can cause:
- wheezing and coughing
- a red, itchy rash
- red, itchy, watery eyes
- a runny or blocked nose
- worsening of asthma or eczema symptoms
Most allergic reactions are mild, but occasionally a severe reaction called anaphylaxis or anaphylactic shock can happen.
This is a medical emergency and needs urgent treatment.
Substances that cause allergic reactions are called allergens.
The more common allergens include:
- insect bites and stings
- dust mites
- medicines – including ibuprofen, aspirin and certain antibiotics
- grass and tree pollen – an allergy to these is known as hay fever (allergic rhinitis)
- food – particularly nuts, fruit, shellfish, eggs and cows’ milk
- latex – used to make some gloves and condoms
- mould – these can release little particles into the air that you can breathe in
- animal dander, tiny flakes of skin or hair
- household chemicals – including those in detergents and hair dyes
Most of these allergens are generally harmless to people who are not allergic to them.
Understanding Aspirin Allergy
Aspirin allergy is characterized by three diverse reactions, each with its own unique set of features.
The reactions can sometimes overlap resulting in symptoms ranging from mild to life-threatening. These include:
- Aspirin-exacerbated urticaria/angioedema, which manifests with dermatological symptoms such as hives and swelling
- Aspirin-exacerbated respiratory disease (AERD), which causes symptoms such as rhinitis and asthma
- Aspirin-exacerbated urticaria with or without angioedema, in which hives and swelling can progress to a potentially life-threatening, all-body reaction known as anaphylaxis
Less commonly, NSAIDs are known to trigger serious conditions such as aseptic meningitis and hypersensitivity pneumonitis, although the mechanisms of these responses are not entirely understood.
In certain situations, an adjusted form of aspirin therapy may be used to assist a person overcome hypersensitivity.
One such example involves persons with severe asthma who require surgery to remove nasals polyps. After undergoing the procedure, doctors will sometimes recommend aspirin desensitization to assist those with AERD better enjoy the benefits of aspirin.
The procedure aims to decrease aspirin sensitivity by exposing the individual to extremely low doses of aspirin and then gradually increasing the dose until he or she is capable to tolerate milligrams. This should only be done under the care of a qualified allergist and only in persons for whom aspirin would provide much-needed relief.
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Aspirin is helpful in treating numerous conditions, from headache to heart disease.
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“However, after taking this simple wonder drug, some people experience adverse reactions,” says David Lang, MD, Chairman of the Department of Allergy and Immunology.
Called aspirin sensitivity, this condition can also be triggered by aspirin-like drugs, such as the non-steroidal anti-inflammatory drugs (NSAIDs) ibuprofen and naproxen.
Aspirin sensitivity takes three forms:
Aspirin Exacerbated Respiratory Disease (AERD)
This first group experiences a reaction to aspirin that may include coughing, wheezing or shortness of breath.
Nasal or sinus congestion, drainage and sneezing also may be present.
AERD generally begins in young adulthood and is associated with a triad of symptoms.
- Moderate-to-severe asthma also develops.
- People with AERD develop chronic nasal or sinus symptoms, including nasal or sinus polyps – benign growths in the upper airway that obstruct airflow and often impair the sense of smell. Generally, sinus surgery is required.
- These patients eventually develop serious respiratory reactions to the casual use of aspirin or aspirin-like drugs.
This can happen even though earlier the patient could tolerate these medications without adverse reaction. The aspirin or a non-steroidal anti-inflammatory drug, such as ibuprofen or naproxen, does not cause the initial nasal or sinus symptoms, but makes it worse.
Patients with AERD may be candidates for a procedure called aspirin desensitization. This procedure can assist a patient tolerate aspirin, and permit the patient to take aspirin without respiratory reaction.
In aspirin desensitization, the patient first takes a extremely low dose of aspirin.
Then the dose is cautiously increased. This is done under shut observation.
Patients generally experience one or two respiratory reactions to aspirin. However, since the dose is little, these reactions are generally milder than earlier ones.
There is, however, a risk of serious respiratory reaction, so this procedure should be performed only at a health care facility with supplies and equipment to manage a serious reaction should it happen, and under the guidance of staff and paraprofessional staff with experience with this procedure.
Once desensitization is accomplished, the patient maintains tolerance to aspirin by taking it daily.
Aspirin desensitization treatment has been associated with improvement in AERD, including reduced nasal or sinus symptoms, improved control of asthma, improved quality of life and reduced need for sinus surgery over time.
Because of this improvement, the risk of serious respiratory reaction to aspirin is outweighed by the potential for benefit.
Urticaria with or without angioedema in the absence of chronic urticaria/angioedema
These patients may experience a reaction to aspirin that may include hives, swelling and itching, but in some cases the reaction may progress to anaphylaxis — a life-threatening allergic reaction that can involve hives, swelling, difficulty breathing, a sensation of the throat closing and lightheadedness. This requires immediate medical attention.
This group does not own an underlying chronic respiratory or skin condition.
These patients own had reactions when taking aspirin, or in some cases an aspirin-like drug such as ibuprofen or naproxen — usually in the form of hives or swelling. They often are erroneously told or assume they are allergic to aspirin and should never take it again.
However, with passage of time, the tendency to react to aspirin may no longer be present.
If you own this third form of aspirin sensitivity, and you require aspirin or an aspirin-like drug for treatment of another condition such as heart disease, you may be avoiding aspirin needlessly and depriving yourself of its benefits for no reason.
No skin test or blood test can determine whether a person has the potential for an adverse reaction to aspirin. The only way to discover this out is to undergo an aspirin challenge procedure.
In the majority of cases, aspirin can be tolerated without adverse reaction.
In an aspirin challenge, the patient first takes a extremely low dose of aspirin. Then the dose is cautiously increased. The procedure is done under shut observation.
Eventually patients in this third group typically are capable to tolerate aspirin without adverse reaction. The reactions that do happen generally are milder than before and reply promptly to treatment.
Because of the risk of serious reaction with re-exposure to aspirin, this challenge procedure should only be performed at a health care facility where supplies and equipment are present to manage a serious reaction should it happen, and under the guidance of staff and paraprofessional staff with experience with the procedure.
Its significant that patients in this third group see a board-certified allergy/immunology physician for an individualized assessment of the risk compared with the benefit of re-exposure to aspirin.
Aspirin sensitivity with underlying airway disease
If you own aspirin-exacerbated respiratory disease (AERD), aspirin may make you cough, wheeze and feel short of breath.
Nose or sinus congestion and drainage can stuff you up and make you sneeze.
“AERD generally begins in young adulthood, and is linked to a triad of symptoms,” says Dr.
- Moderate to severe asthma: Wheezing and difficulty breathing are caused by inflamed/constricted airways.
- Chronic nasal or sinus symptoms, including polyps: Polyps (benign growths that obstruct airflow through the nose and sinuses, and impair the sense of smell) generally require sinus surgery.
- Serious respiratory reactions to casual use: Aspirin or aspirin-like drugs can trigger reactions even if they’ve caused no trouble the past.
In AERD, aspirin does not cause symptoms, but worsens them, Dr.
Lang points out.
The excellent news: Aspirin desensitization allows people with AERD to better tolerate aspirin, avoid respiratory symptoms and enjoy a better quality of life. Over time, it also makes sinus surgery less likely.
“Aspirin desensitization is a procedure in which tolerance to aspirin is induced. This procedure should be performed only by doctors who are knowledgeable about the procedure, at a facility equipped to manage serious respiratory reactions,” stresses Dr. Lang.
Desensitization begins with an aspirin challenge. A extremely low dose of aspirin is given under shut medical observation.
The dose is then cautiously increased.
Patients generally own one or two mild respiratory reactions, then build tolerance, which they maintain by taking aspirin daily.
“The risk of serious respiratory reaction from aspirin desensitization is outweighed by the potential benefits for people with AERD,” he notes.
Aspirin Exacerbated Urticaria/Angioedema
This second group comprises patients with chronic urticaria and angioedema known in laymans terms as hives and swelling.
As with patients in the first group, these conditions are not solely connected to taking aspirin.
The hives and swelling flare up about a third of the time when these patients take aspirin.
Unfortunately, there is no evidence that tolerance to aspirin can be induced in this group. We generally advise that the patient avoid every aspirin and aspirin-like drugs such as ibuprofen and naproxen, and to take acetaminophen instead.
Aspirin sensitivity without underlying skin or airway disease
Sometimes aspirin and aspirin-like drugs trigger hives, itching and/or swelling when there is no chronic respiratory or skin condition.
This type of aspirin sensitivity may progress to anaphylaxis, a life-threatening allergic reaction that may involve hives, swelling, difficulty breathing, a throat-closing sensation and/or lightheadedness.
Anaphylaxis requires immediate medical attention.
“Often, these patients are erroneously told, or assume, that they’re allergic to aspirin and should never take it again,” says Dr.
Lang. “But with the passage of time, they may lose this tendency to react to aspirin.”
If you own this type of sensitivity, and need aspirin or an aspirin-like drug for a condition love heart disease, you may be needlessly depriving yourself of its benefits.
No skin test or blood test can predict the potential for sudden adverse reactions to aspirin. The only way to confirm this is through an aspirin challenge.
“But patients with this type of aspirin sensitivity should first see a specialist board-certified in allergy and immunology to assess the risks and benefits of aspirin re-exposure,” says Dr. Lang.
Again, the aspirin challenge must be done by an experienced team at a well-equipped facility.
Aspirin sensitivity with underlying skin disease
If you often get hives and swelling (a condition called chronic urticaria and angioedema), you may react adversely to aspirin — but not every time.
“Typically, one out of three times, hives and swelling will flare up after taking aspirin,” says Dr.
Lang. “Again, these symptoms are not solely connected to taking aspirin.”
Unfortunately, doctors own not yet found a way to assist patients with chronic hives and swelling build tolerance to aspirin.
“We generally advise these patients to avoid every aspirin and aspirin-like drugs, such as ibuprofen and naproxen, and to take acetaminophen instead,” he says.
Talk to your doctor
So should you stop taking aspirin, ibuprofen or naproxen if you own an adverse reaction?
Yes. But you should also talk to your doctor about your aspirin sensitivity — especially if you drop into one of the groups above.
An aspirin challenge or desensitization may permit properly selected patients to resume taking this beneficial drug.
Contributor: David Lang, MD, Chair of Department of Allergy and Immunology, Cleveland Clinic
Cleveland Clinic is a non-profit academic medical middle.
Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.
Aspirin can be extremely helpful in treating numerous conditions from a headache to heart disease. However, when some people take this simple wonder drug, they experience one of a few types of adverse reactions, known as aspirin sensitivity.
There are three groups of patients with aspirin sensitivity:
Talk to your doctor
So if you notice adverse reactions after taking aspirin, you should avoid taking it and other aspirin-like drugs such as ibuprofen and naproxen.
But talk to your doctor about your aspirin sensitivity especially if you fit into groups 1 or 3 above.
You could be a candidate for undergoing an aspirin challenge.
An allergy is a reaction the body has to a specific food or substance.
Allergies are extremely common. They’re thought to affect more than 1 in 4 people in the UK at some point in their lives.
They’re particularly common in children. Some allergies go away as a kid gets older, although many are lifelong.
Adults can develop allergies to things they were not previously allergic to.
Having an allergy can be a nuisance and affect your everyday activities, but most allergic reactions are mild and can be largely kept under control.
Severe reactions can occasionally happen, but these are uncommon.
Allergies to pollens, cat dander, and foods can be diagnosed by testing the blood for so-called allergic antibodies.
This type of antibody response does not generally happen with NSAIDs. As such, allergies of this sort are most often diagnosed presumptively based on the appearance and timing of symptoms.
In severe cases, an oral challenge test may be used to see how a person reacts to a specific NSAID. This should only be done under the supervision of a certified allergist.
Getting assist for allergies
See a GP if you ponder you or your kid might own had an allergic reaction to something.
The symptoms of an allergic reaction can also be caused by other conditions.
A GP can assist determine whether it’s likely you own an allergy.
If they ponder you might own a mild allergy, they can offer advice and treatment to assist manage the condition.
If your allergy is particularly severe or it’s not clear what you’re allergic to, they may refer you to an allergy specialist for testing and advice about treatment.
Find out more about allergy testing