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Aspirin Allergy

Aspirin can save lives!  Aspirin allergy can take lives!

What happens if I’m allergic to aspirin?

Several types of adverse reactions can occur after taking aspirin.

  • Aspirin-Induced Asthma also known as AERD (Aspirin-Exacerbated Respiratory Disease):  within 3 hours of taking aspirin or NSAID (Non-Steroidal Anti-Inflammatory) such as ibuprofen, the asthma flares and nasal congestion and discharge occur.  These reactions can be violent and may lead to severe difficulty breathing.
  • Anaphylaxis: this can be mediated by the allergic antibody IgE, but allergy skin or blood testing is not reliable. These can be life threatening.
  • Urticaria/Angioedema:  hives and swelling occur especially in patients who already have chronic hives of unclear cause.
  • Tinnitus:  ringing in the ears can occur from taking too much aspirin.
  • Stomach ulcers:  (peptic ulcer in the stomach) this is not a reaction, but a side effect where the stomach lining becomes inflamed and ulcerated.  These are more common if using multiple NSAIDs, long duration of use, more likely in those age 60 or older, more common in women than men, a history of peptic ulcers, those who smoke, drink alcohol and are taking corticosteroids, such as prednisone.

How common is aspirin allergy?  This depends on the population being tested.  Usually aspirin allergy occurs in adults.

  • In the general population, the prevalence of aspirin hypersensitivity ranges from 0.6% to 2.5%.
  • Up to 21% of patients with asthma will have asthma triggered by aspirin.
  • For those patients with nasal polyps and chronic sinus problems, the prevalence is about 30-40%.

How is Aspirin allergy diagnosed?  There is no available skin or blood test to confirm aspirin hypersensitivity.  While the symptoms following aspirin or NSAID ingestion can be suggestive, the diagnosis is confirmed with a challenge—taking aspirin and monitoring for a reaction.  This is not without risk.

Treatment of Aspirin Hypersensitivity:

Avoid aspirin (the most important): it is very important to read medication labels to make sure they do not contain aspirin.  Most patients with aspirin allergy can tolerate acetaminophen (Tylenol) at usual doses.

Cross reactivity with NSAIDs like ibuprofen:  for patients with asthma nearly all NSAIDs will have cross reactivity, but for those patients with hives, the cross reactivity with other NSAIDs is less predictable.

In special circumstances, where aspirin can be life-saving despite an allergy to it, desensitization can be performed under direct and close supervision.

Hippocrates used aspirin-like products (salicylates) in the form of willow tree bark to treat fever and pain. Aspirin was introduced into medicine in 1899. The first reported case of allergic reaction to aspirin was 3 years later in 1902.

Aspirin:  one of the great medications of all time, but…..also one that can potentially be very dangerous!

This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional. 


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