Approach to the patient with a history of adverse reactions to aspirin or NSAIDs: diagnosis and treatment.

Aspirin and nonsteroidal antiinflammatory drugs can induce several different reactions. It is incumbant upon the astute physician to recognize the differences between these reactions, the clinical settings in which they occur, and the management of each type of reaction. In this article, I have attempted to clarify and simplify, as much as possible, the approach I take in addressing the problems of adverse reactions to these drugs. In addition, the problems of cross-reactions are explained in terms of COX-1 and 2 isoenzymes. Aspirin desensitization and treatment with daily ASA are also addressed.