Aspirin Sensitivity – Signs and symptoms, Treatment

Aspirin Sensitivity

Summary

Aspirin sensitivity occurs in people who have potentially dangerous reactions when taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). About 10 percent of adults with asthma have symptoms triggered by taking these drugs, according to the American Academy of Allergy, Asthma and Immunology. These asthma attacks are often severe, and in some cases can be life-threatening.

Other forms of sensitivity to aspirin also exist. Some people have severe reactions to aspirin that are similar to an allergic reaction. Symptoms typically include nasal discharge (rhinorrhea), swelling, nasal polyps and anaphylactic shock, which is a rare, life-threatening allergic reaction. Those who are allergic to aspirin are also likely to experience similar symptoms when taking other NSAIDs.

Aspirin and other NSAIDs can also cause stomach ulcers, increase the likelihood of skin bruises and bleeding, and harm the liver and kidneys in some people. Those with a history of reacting to aspirin should avoid all NSAIDs, including ibuprofen, naproxen and ketoprofen.

Sometimes, NSAIDs are found as ingredients in other medications used to treat colds and cough, pain, and fever. For this reason, it is important that patients with aspirin sensitivity consult a physician before taking any new drug.

About aspirin sensitivity

Aspirin sensitivity is a condition in which people have strong reactions to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). These reactions include asthma attacks, symptoms that mimic those of an allergic reaction, and gastrointestinal problems.

Aspirin and other NSAIDs are used to reduce inflammation and relieve pain and fever. They do so by inhibiting an enzyme called cyclooxygenase-1 (COX-1). This enzyme is a prime factor in the production of prostaglandins, chemicals that trigger inflammation and pain within the body.

As the drugs inhibit COX-1, they clear the way for other enzymes. In some people, however, this can be harmful. The enzymes can release chemicals that cause inflammation and narrowing of the airways, as well as increased mucus production, triggering an asthma attack.  

Most reactions to aspirin or other NSAIDs fall into two different categories:

  • Respiratory reactions such as wheezing, runny nose, shortness of breath

  • Skin reactions such as hives (urticaria) and swelling (angioedema)

Although the symptoms of aspirin sensitivity may mimic those of an allergic reaction, the condition is not considered a true allergy because the immune system is not involved.

NSAIDs include both prescription and nonprescription drugs such as:

  • aspirin (nonprescription)
  • ibuprofen (nonprescription)
  • naproxen (nonprescription)
  • ketoprofen (nonprescription)
  • diclofenac (prescription)
  • etodolac (prescription)
  • fenoprofen (prescription)
  • indomethacin (prescription)
  • ketoprofen (prescription)
  • ketoralac (prescription)
  • oxaprozin (prescription)
  • nabumetone (prescription)
  • sulindac (prescription)
  • tolmetin (prescription)

Aspirin sensitivity is most likely to affect those who suffer from both moderate to severe asthma and chronic rhinosinusitis. It is more often found in females and becomes more likely as people age or as their asthma progresses.

Acetaminophen has long been considered a good alternative to NSAIDs for reducing pain or fever. However, recent studies have shown that high doses of this drug can also provoke asthma attacks in some people. In addition, acetaminophen lacks the anti-inflammatory properties of NSAIDs.

A newer class of pain and inflammation medication called COX-2 inhibitors is generally viewed as likely to cause a reaction in patients with aspirin sensitivity. Data released by the U.S. Food and Drug Administration (FDA) shows that some NSAIDs – particularly some types of COX-2 inhibitors – may cause an increased risk of cardiovascular events. Two COX-2 inhibitors, rofecoxib and valdecoxib, have been completely removed from the market. Rofecoxib was found to increase the risk of heart attack and stroke. Valdecoxib was taken off the market because of cardiovascular and gastrointestinal risks. The use of valdecoxib was also found to increase the rate of rare serious skin reactions. Patients should consult their physician when weighing alternatives to aspirin and other NSAIDs.

Related allergies and conditions

Some people with aspirin sensitivity may also be sensitive to various foods or other drugs. Symptoms triggered by aspirin may also appear when using other nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, these drugs are found in other medications used to treat colds and cough, pain, and fever. Patients with aspirin sensitivity should not take any drug without first consulting a physician, and should be careful to avoid any medication with the word “salicylate” or “salicylic acid” in the list of active ingredients.

Those with aspirin sensitivity may also react to the food dye FD&C Yellow No. 5 (also known as tartrazine) and sodium benzoate, a preservative. People who are sensitive to aspirin may be encouraged to create a diet plan that is salicylate–free. Salicylates occur naturally in many plants and act as a plant hormone.

Foods that contain salicylates include:

  • Apples, berries, dried fruit
  • Peanuts
  • Broccoli, peppers
  • Instant coffee, wine, beer
  • Processed cheese and meats
  • Vinegar

People with salicylate sensitivity may be able to eat some foods containing salicylates but not others. For instance, some people may be able to consume foods that are peeled or cooked, rather than raw.

Signs and symptoms of aspirin sensitivity

Some of the conditions and symptoms associated with aspirin sensitivity include:

  • Asthma. Usually appears as part of Samter’s triad, which includes three elements: aspirin sensitivity, nasal polyps (sac-like growths in the nose) and asthma. About 10 percent of adults with asthma (and 40 percent with nasal polyps) have symptoms triggered by taking these drugs, according to the American Academy of Allergy, Asthma and Immunology. These asthma attacks are often severe, and in some cases can be life-threatening.
  • Severe allergic-type reactions. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the enzyme cyclooxygenase, which keeps prostaglandins from triggering pain and inflammation. However, in aspirin-sensitive individuals, production of leukotrienes increases. Leukotrienes are powerful bronchodilators and vasodilators that can trigger symptoms similar to those of an allergic reaction. Symptoms that typically appear include nasal discharge (rhinorrhea), nasal polyps and – very rarely – anaphylactic shock, which is a life-threatening allergic reaction.
  • Urticaria and angioedema. According to the American Academy of Allergy, Asthma and Immunology (AAAAI), 20 to 80 percent of people with chronic (ongoing) urticaria (hives) and angioedema (swelling) will experience a worsening of the conditions after taking the drugs. This can result in swelling of the airway. Individuals with urticaria and angioedema should consult a physician before using aspirin.

  • Reye syndrome. A rare condition that causes swelling of the brain and fatty deposits in the liver of children who take aspirin to treat fever brought on by chicken pox, flu and other viral infections. Symptoms include vomiting, confusion, loss of consciousness and high blood pressure. Severe cases can cause brain damage or death. Parents and other caregivers should avoid giving aspirin or other NSAIDs to a child unless advised to do so by a physician.

  • Gastrointestinal problems. NSAIDs help relieve pain and inflammation by suppressing chemicals in the body called prostaglandins. However, prostaglandins also protect the stomach lining, because they suppress the risk of gastric acid eroding the stomach lining and causing bleeding and ulcers.

  • Bruising and bleeding. NSAIDs have anticoagulant effects, causing some people to bruise or bleed more easily. In addition, use of aspirin during pregnancy may affect the clotting mechanisms of both the mother and the fetus, leading to an increased risk of bleeding. This is especially true if high doses of aspirin are taken.

Other general symptoms of sensitivity to NSAIDs include:

  • Ringing in the ears
  • Headache
  • Runny nose
  • Itchy, watery, swollen eyes
  • Dizziness
  • Cough
  • Drowsiness
  • Breathing difficulties
  • Wheezing
  • Mouth sores
  • Skin rashes

Individuals who suspect sensitivity to aspirin or other NSAIDs should avoid the drug and consult a physician.

Diagnosis methods for aspirin sensitivity

A physician will conduct a full physical examination of the patient as well as compile a medical history and a list of symptoms.

Sensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) is not mediated by immunoglobulin E (IgE), so skin testing is not an effective means of ruling out the diagnosis. Instead, a physician will rely on a personal medical history, or possibly an aspirin challenge test. During the latter, a physician will intentionally introduce a low dose of aspirin to the patient to watch for a reaction. Such a test must be performed by a physician in a proper medical facility, as a dangerous reaction can result that requires immediate treatment.

Treatment and prevention of aspirin sensitivity

Avoidance is the best technique for preventing symptoms in those with aspirin sensitivity. In addition to avoiding aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), patients should be aware that these drugs often are found in other medications used to treat colds and cough, pain, and fever.

The three elements in Samter’s triad are treated separately with avoidance (aspirin sensitivity), surgery or corticosteroids (nasal polyps) and general treatments for the asthma component. A small percentage of those with Samter’s triad will also develop hives or angioedema. These are treated with antihistamines and corticosteroids.

Patients who require aspirin therapy for cardiovascular or rheumatic diseases may need to undergo drug desensitization therapy until their body eventually stops reacting to aspirin. This must be done under close physician supervision, with dosage levels gradually increased while the patient is closely monitored. Patients then will need to take aspirin every day to maintain the desensitized state.

Because the success of drug desensitization therapy depends on the severity of the reaction, not all patients who require aspirin are candidates for the treatment. Patients who experience breathing problems with aspirin are better candidates for desensitization than patients who develop hives.  

In addition, while antihistamines have not proved effective in treating aspirin sensitivity, leukotriene modifiers do appear to be effective in inhibiting reactions.

Patients should not take any drug without first consulting a physician, and should be careful to avoid any medication with the word “salicylate” in the list of active ingredients.

Questions for your doctor on aspirin sensitivity

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding aspirin sensitivity:

  1. Do my symptoms indicate aspirin sensitivity?
  2. What methods will you use to determine if I have aspirin sensitivity?
  3. Is aspirin sensitivity dangerous to my overall health?
  4. Will I have to avoid aspirin for the rest of my life?
  5. Are there drugs besides aspirin that I should avoid?
  6. How can I tell if a medication contains aspirin or another NSAID?
  7. What should I do if I accidentally take a medication with aspirin in it?
  8. What drugs can I safely take to relieve inflammation or reduce pain or fever?
  9. Are there certain foods I should avoid as well?
  10. Am I a candidate for desensitization?
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