Nov. 17, 2000 -- "An aspirin a day" to prevent heart attacks and stroke is good medicine for most people with heart disease -- except for those who also have problems with aspirin. In those cases, the "cure" comes encumbered with a package: hives, a runny nose, stomach problems, or even asthma symptoms.
When patients have a drug allergy or hypersensitivity, typically they avoid the medication entirely. Considering the benefits of aspirin in the prevention of heart attack and stroke, doctors have felt limited in their ability to give effective preventive medicine to people with aspirin-induced asthma who have also had a prior heart attack or stroke, or who otherwise have severe heart disease.
Now, these patients can be "desensitized" so that they can take aspirin safely, according to British researchers who published a review article recently in the journal Chest. Desensitization is commonly used in the treatment of allergies. For example, when patients get immunotherapy in the form of allergy shots, they become desensitized to the offending substances, such as pollen, by getting a small amount of the substance injected into their skin. Eventually, they develop a tolerance and react less strongly. The same principle applies with aspirin desensitization, although small amounts of aspirin are either taken orally or inhaled.
Study author Suresh Babu, MD, explains the potential benefits of aspirin desensitization. "The presence of aspirin sensitivity implies that all the patient needs to do is to avoid this drug," he tells WebMD. "However, a small number of patients, who have [additional] diseases which warrant aspirin therapy, could be considered for desensitization."
Although other medications can occasionally be used, sometimes aspirin is the best therapy. Desensitization is appropriate for such patients, says Babu. He is a pulmonologist with respiratory and cell molecular biology at the University of Southampton, in England.
Aspirin desensitization is carried out over a course of several days. In the first two to three days, patients ingest small, gradually increasing doses of aspirin until it is tolerated. They then can take aspirin daily.
Desensitization is not an unmixed blessing, though. "Once the necessary dosage is reached, the patient should take aspirin every day," Babu tells WebMD. "If he or she had to stop the aspirin for a week or so, then the whole process of desensitization should be started all over again." However, if another medication can provide the same level of protection against heart attack and stroke, those medications should be used instead, he says.
Experts are still weighing the benefits and risks of aspirin desensitization. Although patients with respiratory reactions to aspirin can be desensitized, "this is not necessarily possible for [hives]. This is an important distinction," Mark Dykewicz, MD, tells WebMD. "For people who can be desensitized, though, there may be benefits in addition to ability to tolerate aspirin."
For example, some people with nasal allergies sometimes have an improvement in those symptoms, as well as becoming more aspirin-tolerant, says Dykewicz. He is a co-author of the drug hypersensitivity guidelines issued by the American College of Allergy, Asthma, and Immunology. He is also an associate professor of internal medicine and the director of allergy and immunology at St. Louis University School of Medicine.
Not all physicians are convinced of the wisdom of aspirin desensitization.
"I feel that aspirin desensitization is not a great idea. Aspirin-induced asthma is not common in the general population, and there are alternatives to aspirin for patients who also have [heart] disease," Omar Termizi, MD, tells WebMD. "Since aspirin desensitization has to be continued, it's not feasible if you have to do it again and again." For patients with heart disease, other anticlotting medications may be appropriate, says Termizi. He is a pulmonologist at Brotman Medical Center in Culver City, Calif.
Nonetheless, this finding could be important news for some aspirin-sensitive patients. But all aspirin-sensitive patients should consult their doctor to see if this is an appropriate option, if there are other medications that are better for their condition, or if there are other drugs they should avoid.