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Aspirin allergy does not have to hinder heart care

Omar Wani, M.D.

People who undergo cardiac procedures often get a new lease on life. Once again, their heart can pump blood to a body previously starved of oxygen. To remain successful, this new life has some non-negotiables—a nutritious diet, exercise and medication. For many, therapy includes a low dose “aspirin a day” regimen which improves the outcome for cardiac patients. Unfortunately, it’s not uncommon for some people to have an aspirin allergy.

Although aspirin is normally a well-tolerated drug, like any medication, some people have an allergic reaction to it.  An allergy to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen is not unusual and may cause the same symptoms as other allergy triggers do. The immune system kicks into high gear, and the body tries to fight off what is a normal substance for others. Common symptoms include:   itchy, watery eyes; nasal congestion; rashes or hives; coughing and wheezing or worsening asthma; and in rare cases, anaphylactic shock.

Aspirin allergy is a major setback in treating acute coronary problems. According to a 2007 article in The Journal of the American Medical Association, approximately 36 percent of U.S. adults take aspirin regularly for long-term prevention of cardiovascular disease. That number rises to 80 percent among heart patients. A typical dose of 81 milligrams per day reduces coronary artery disease by 33 percent, so daily aspirin use plays a key role in preventing complications for these patients.

Aspirin sensitivity also can cause difficulties implanting stents to open blocked passageways of the heart. In effect, it not only limits patients’ initial surgery, but also, the full, long-term benefits of aspirin use for the best possible care afterward.

Fortunately, like many other allergies, aspirin or acetylsalicylic acid sensitivity is common, and desensitization often can be performed safely in most patients. The idea is that constant exposure to low doses allows the body to accept aspirin instead of reacting to it. Afterward, patients can manage their daily dose to stay healthy without worry.

Aspirin desensitization is performed in a controlled setting where the patient receives low doses of aspirin through an IV in a Cardiovascular Intensive Care Unit. An IV is the fastest way to administer drugs throughout the body, and if a serious reaction does occur, it can be reversed with proper medication immediately.  Slowly, the aspirin is increased until a full dose can be accepted. When a patient can manage a full dose of aspirin or NSAIDs, desensitization is complete. Patients are watched during the process to ensure safety. A nurse is continually present and two specialized physicians - a cardiologist and an allergist/immunologist - monitor the procedure. If a reaction should occur, it can be quickly treated in this supervised, medical setting. Several breathing tests are given throughout to assure the patient is safe and comfortable. 

Alleviating aspirin allergy through this novel, rapid desensitization process is a boon to managing coronary artery disease, and is a necessary treatment option especially for those diagnosed with coronary artery disease.

Omar Wani, M.D., interventional cardiologist, is the medical director of Flagstaff Medical Center’s Cardiac Rehabilitation and a member of the Heart & Vascular Center of Northern Arizona. Specializing in interventional cardiac and vascular medicine, Dr. Wani is well-respected for his extensive research in cardiovascular medicine, which includes published articles, reference books and presentations.