000370 - Desensitization to Acetylsalicylic Acid (ASA): a case report

Background

Aspirin desensitization is a cornerstone of the management of patients with cardiovascular disease and a history of ASA hypersensitivity, including anaphylactic reactions, and/or with a diagnosis of cross-reactive NSAID (non steroid antiinflammatory drug) hypersensitivity. We present a case of successful desensitization in a patient with NSAID-induced urticaria / angioedema / anaphylaxis (NIUAA).

Method

The patient was a 56 year old male with a history of 4 episodes of acute urticaria and acute severe dyspnea 2 hours after intake of Aspirin, Naproxen, Disclofenac and Ibuprofen, respectively, requiring dual antiplatelet therapy (aspirine plus an adenosine-diphosphate receptor antagonist) and a preventative percutaneous coronary intervention. The patient did not suffer from asthma or chronic rinosinusitis with nasal polyps, but based on spirometry and endoscopic findings pretreatment with inh ICS/LABA, budesonide nasal spray and montelukast po was given for 1 week (prior to desensitization). Desensitization to ASA was undertaken using the protocol published in recent EAACI Guidelines with the following doses: 1mg, 2mg, 5mg, 10mg, 15mg  - (20 minute intervals), 25mg - (40 minute interval from last dose), 40mg, 80mg - (60 minute interval from last dose and inbetween), using a 10mg/ml solution.

Results

Aspirin desensitization was performed with 1-day protocol and was successful. On the next day the patient received 100mg of ASA and underwent percutaneous coronary intervention without stent placement. Following this intervention, he continued with daily intake of 80mg of ASA.

Conclusions

ASA/NSAID hypersensitivity has many phenotypes including anaphylactic reactions to ASA and cross-reactive NSAIDs. It is important to report such cases in order to confirm the practical use of published guidelines.