Can we beat aspirin allergy?

The study assessed the safety and efficacy of a desensitization protocol for aspirin (acetylsalicylic acid) sensitive (allergic) patients undergoing coronary stent implantation.

A coronary stent is a thin tube placed in the coronary arteries that supply blood and oxygen to the heart, to keep them open, as a treatment of coronary artery disease (CAD). The procedure of unblocking the coronary arteries using a deflated balloon and stents is called angioplasty. Stents reduce chest pain and have been shown to improve survival in the event of an acute myocardial infarction (heart attack). After the procedure, patients are treated with dual anti platelet therapy or DAPT (such as aspirin and clopidogrel) for a recommended duration depending on type of stent. These drugs lower the risk of stent thrombosis (formation of blood clots around or into the stent). Some patients may be allergic to aspirin, which makes it more difficult to prevent stent thrombosis for these patients. A procedure called aspirin desensitization which is used to reduce or eliminate patients’ negative reaction to aspirin due to sensitivity (allergy) by repeated exposure to it may be useful in treating patients undergoing coronary stent implantation.

The study involved 43 patients who had a history of aspirin sensitivity and had to undergo angioplasty. The patients were subjected to a desensitization protocol for 4.5 hours. Each patient was administered intravenously (by injection directly into the vein) with progressive doses of aspirin, starting with a dose of 1mg of aspirin. The dose was doubled after every 30 minutes. Thus, the doses to be administered were 1mg, 2mg, 4mg, 8mg, 16mg, 32 mg, 64mg, 125mg and 250mg aspirin, the last dose being administered after 4.5 hours from the beginning of the protocol.

Desensitization was successful in 42 patients while unsuccessful in only 1 patient who had chronic idiopathic urticaria (occurrence of red weal and itching daily for at least 6 weeks, with no obvious cause). The 42 successful patients underwent stent implantation and follow up was done for at least 30 days up to 12 months to check how they were responding to aspirin therapy. All the 42 patients did not have allergic reactions to aspirin after the desensitization protocol. The event-free survival (defined as the percentage of patients who remained free of complications after treatment) was 97.2%.

In summary, the aspirin desensitization protocol was found to be safe and efficient  in aspirin-sensitive patients undergoing coronary stent implantation.

Consult your physician on the application of a desensitization protocol in your case.