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Nonsteroidal anti-inflammatory hypersensitivity. How to give sensitive patients the benefit of cardiovascular protection ? Volume 16, issue 8, Octobre 2004

Authors
Service de Pneumologie, Hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France

Acetylsalicylic acid (ASA) commonly known as aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDS) are among the drugs most commonly used all over the world. NSAIDS were reported to be the cause of 21% of all adverse drug reactions. Aspirin is indicated in the treatment of coronary artery disease and after a myocardial infarction. Many patients are denied treatment with ASA because of a history of ASA or nonsteroidal anti-inflammatory drug-induced urticaria or angioedema, or rhinosinusitis or asthma or anaphylactoid reactions. The mecanism of ASA hypersensitivity appears to be pharmacological rather than immunological, by specific blockage of cyclo-oygenase (COX), the way promoting synthesis of leucotriene, the main agent involved in the clinical manifestations. The diagnosis of hypersensitivity is based on the clinical history, and sometimes on oral, inhaled, or nasal provocation tests with ASA. Then, the demonstration of hypersensitivity implies the complete avoidance of the ASA molecule and the entire class of drug. However subjects who have cardio-vascular disease, can be challenged-desensitised by oral protocols based on rapidly escalating doses of ASA, under medical monotoring.