Establishing a Safe Administration of ASA in Cardiovascular Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity with Skin and/or Respiratory Involvement

被引:12
作者
Al-Ahmad, Mona [1 ]
Rodriguez-Bouza, Tito [2 ]
Nurkic, Midhat [3 ]
机构
[1] Kuwait Univ, Fac Med, Microbiol Dept, POB 24923, Safat 13110, Kuwait
[2] Al Rashed Allergy Ctr, Minist Hlth, Kuwait, Kuwait
[3] Sabah Al Ahmed Cardiac Ctr, Minist Hlth, Kuwait, Kuwait
关键词
Nonsteroidal anti-inflammatory drugs; Challenge; Desensitization; Coronary angioplasty; High-risk patients; PERCUTANEOUS CORONARY INTERVENTION; ASPIRIN DESENSITIZATION; RAPID DESENSITIZATION; METAANALYSIS; GUIDELINES; CHALLENGE; DISEASE; ALLERGY; PREVENTION; URTICARIA;
D O I
10.1159/000486415
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Background: A history of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity with cross-intolerance to several drugs is common in some patients with coronary artery disease. We present a series of patients with acute coronary syndrome undergoing ASA desensitization prior to a possible stent to evaluate the short- and long-term efficacy and safety. The aim was to evaluate the outcomes of an ASA desensitization protocol developed by our center based on the guidelines proposed by the EAACI drug allergy expert recommendations. Methods: We developed a desensitization protocol that was based on both the patient characteristics and onset of reaction after NSAIDs, including premedication with a leukotriene antagonist and the H1-antagonist antihistamine. The clinical entities were NSAID-induced urticaria and/or angioedema in the absence of chronic spontaneous urticaria (NIUA) and NSAID-exacerbated respiratory disease (NERD). Results: A total of 23 patients were challenged or desensitized with ASA: 19 NIUA and 4 NERD. All patients tolerated the protocol at the different times of 30, 45, 90, and 120 min. The dosages of oral ASA that were given included 10, 21, 41, 81, and 162 mg (cumulative dose 315 mg). One patient reacted during the procedure and 1 during follow-up. Symptoms were limited to the skin without manifestations in other organs. All patients tolerated the required dose of ASA within 30-120 min. Those requiring urgent catheterization were desensitized within 90 min. Conclusions: Our protocol addresses challenge or desensitization with the contribution of a specialist allergist. It provides an effective, dynamic, safe, and short administration of 81 mg or higher of ASA in patients with a history of NSAID hypersensitivity with skin involvement. (C) 2018 S. Karger AG, Basel
引用
收藏
页码:237 / 245
页数:9
相关论文
共 43 条
[1]  
Amsterdam EA, 2014, CIRCULATION, V130, P2354, DOI 10.1161/CIR.0000000000000133
[2]   Meta-Analysis of Multiple Primary Prevention Trials of Cardiovascular Events Using Aspirin [J].
Bartolucci, Alfred A. ;
Tendera, Michal ;
Howard, George .
AMERICAN JOURNAL OF CARDIOLOGY, 2011, 107 (12) :1796-1801
[3]   Efficacy and Safety of Available Protocols for Aspirin Hypersensitivity for Patients Undergoing Percutaneous Coronary Intervention A Survey and Systematic Review [J].
Bianco, Matteo ;
Bernardi, Alessandro ;
D'Ascenzo, Fabrizio ;
Cerrato, Enrico ;
Omede, Pierluigi ;
Montefusco, Antonio ;
DiNicolantonio, James J. ;
Zoccai, Giuseppe Biondi ;
Varbella, Ferdinando ;
Carini, Giovanni ;
Moretti, Claudio ;
Pozzi, Roberto ;
Gaita, Fiorenzo .
CIRCULATION-CARDIOVASCULAR INTERVENTIONS, 2016, 9 (01)
[4]   A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease [J].
Biondi-Zoccai, Giuseppe G. L. ;
Lotrionte, Marzia ;
Agostoni, Pierfrancesco ;
Abbate, Antonio ;
Fusaro, Massimiliano ;
Burzotta, Francesco ;
Testa, Luca ;
Sheiban, Imad ;
Sangiorgi, Giuseppe .
EUROPEAN HEART JOURNAL, 2006, 27 (22) :2667-2674
[5]   Adverse and Hypersensitivity Reactions to Prescription Nonsteroidal Anti-Inflammatory Agents in a Large Health Care System [J].
Blumenthal, Kimberly G. ;
Lai, Kenneth H. ;
Huang, Mingshu ;
Wallace, Zachary S. ;
Wickner, Paige G. ;
Zhou, Li .
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, 2017, 5 (03) :737-+
[6]   Desensitization for drug aflergy [J].
Castells, Mariana .
CURRENT OPINION IN ALLERGY AND CLINICAL IMMUNOLOGY, 2006, 6 (06) :476-481
[7]  
Christou A, 2011, HELL J CARDIOL, V52, P307
[8]  
Collins R, 2009, LANCET, V373, P1849, DOI 10.1016/S0140-6736(09)60503-1
[9]   Rapid Aspirin Challenge in Patients with Aspirin Allergy and Acute Coronary Syndromes [J].
Cook, Kevin A. ;
White, Andrew A. .
CURRENT ALLERGY AND ASTHMA REPORTS, 2016, 16 (02) :1-7
[10]   Early aspirin desensitization in unstable patients with acute coronary syndrome: Short and long-term efficacy and safety [J].
Cordoba-Soriano, Juan Gabriel ;
Corbi-Pascual, Miguel ;
Lopez-Neyra, Isabel ;
Navarro-Cuartero, Javier ;
Hidalgo-Olivares, Victor ;
Barrionuevo-Sanchez, Maria Isabel ;
Prieto-Mateos, Daniel ;
Gutierrez-Diez, Antonio ;
Gallardo-Lopez, Arsenio ;
Fuentes-Manso, Raquel ;
Gomez-Perez, Alberto ;
Lafuente-Gormaz, Carlos ;
Jimenez-Mazuecos, Jesus .
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE, 2016, 5 (07) :41-50