Gabriele Cortellini1, Cristiano Caruso, Antonino Romano. 1. aInternal Medicine and Rheumatology Department, Azienda Sanitaria Romagna, Rimini Hospital, Rimini bAllergy Unit, Fondazione Policlinico Gemelli - Presidio Columbus cAllergy Unit, Presidio Columbus, Rome dIRCCS Oasi Maria S.S., Troina, Italy.
Abstract
PURPOSE OF REVIEW: To investigate the current approach to aspirin challenge (drug provocation) and/or desensitization in patients with histories of hypersensitivity reactions to it, particularly in those with cardiovascular diseases. RECENT FINDINGS: The literature indicates that patients with coronary artery disease (CAD), including those with an acute coronary syndrome, may safely undergo low-dose aspirin challenge and/or desensitization. Recently, flowcharts regarding challenge/desensitization procedures with aspirin in patients with CAD and histories of aspirin hypersensitivity reactions have become available. Aspirin desensitization and continuous aspirin therapy constitute an effective option in patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory diseases (NERD) who have suboptimally controlled asthma or rhinosinusitis, or require multiple revision polypectomies. SUMMARY: The use of aspirin has proven to reduce morbidity and mortality associated with CAD. There is a general consensus on aspirin's effectiveness in secondary prevention of CAD. Therefore, aspirin desensitization is necessary in patients with CAD and histories of hypersensitivity reactions to it. The effectiveness of aspirin desensitization and continuous therapy in patients with NERD has been shown in numerous studies. However, shared selection criteria of candidates for aspirin challenge/desensitization procedures, and simple and homogeneous protocols are necessary. Moreover, preventive safety measures are still needed in order to reduce the potential risks of these procedures.
PURPOSE OF REVIEW: To investigate the current approach to aspirin challenge (drug provocation) and/or desensitization in patients with histories of hypersensitivity reactions to it, particularly in those with cardiovascular diseases. RECENT FINDINGS: The literature indicates that patients with coronary artery disease (CAD), including those with an acute coronary syndrome, may safely undergo low-dose aspirin challenge and/or desensitization. Recently, flowcharts regarding challenge/desensitization procedures with aspirin in patients with CAD and histories of aspirinhypersensitivity reactions have become available. Aspirin desensitization and continuous aspirin therapy constitute an effective option in patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory diseases (NERD) who have suboptimally controlled asthma or rhinosinusitis, or require multiple revision polypectomies. SUMMARY: The use of aspirin has proven to reduce morbidity and mortality associated with CAD. There is a general consensus on aspirin's effectiveness in secondary prevention of CAD. Therefore, aspirin desensitization is necessary in patients with CAD and histories of hypersensitivity reactions to it. The effectiveness of aspirin desensitization and continuous therapy in patients with NERD has been shown in numerous studies. However, shared selection criteria of candidates for aspirin challenge/desensitization procedures, and simple and homogeneous protocols are necessary. Moreover, preventive safety measures are still needed in order to reduce the potential risks of these procedures.
Authors: Cemal Cingi; Nuray Bayar Muluk; Dimitrios I Mitsias; Nikolaos G Papadopoulos; Ludger Klimek; Anu Laulajainen-Hongisto; Maija Hytönen; Sanna Katriina Toppila-Salmi; Glenis Kathleen Scadding Journal: Front Allergy Date: 2021-02-22
Authors: C Caruso; S Colantuono; D Pugliese; C Di Mario; B Tolusso; E Gremese; G Papparella; F Castrì; A Gasbarrini; A Romano; A Armuzzi Journal: Allergy Asthma Clin Immunol Date: 2020-04-22 Impact factor: 3.406