[Acetylsalicylic acid: hypersensitivity, intolerance, or allergy?]

Area of Science:

• Pharmacology
• Immunology
• Toxicology

Background:

• Acetyl salicylic acid (ASA) has been used therapeutically for a century.
• The precise mechanisms underlying ASA's therapeutic effects and adverse reactions in sensitive individuals are not fully understood.
• Non-steroidal anti-inflammatory drugs (NSAIDs) share similar reaction pathways.

Purpose of the Study:

• To review and consolidate the proposed mechanisms of acetyl salicylic acid (ASA) and NSAID hypersensitivity.
• To highlight the complexity and multifactorial nature of these reactions.
• To emphasize the need for accurate diagnosis in managing ASA/NSAID sensitivity.

Main Methods:

• Literature review of scientific results published over the last century.
• Analysis of proposed mechanisms including humoral, cellular, enzymatic, and protein-binding pathways.
• Comparison of ASA/NSAID reaction components with those of anaphylactic reactions.

Main Results:

• Multiple mechanisms are implicated in ASA/NSAID hypersensitivity.
• These include humoral immune reactions (IgE, IgG), cellular immune reactions (lymphocytes), cyclooxygenase inhibition, cellular activation (mast cells, basophils, eosinophils, platelets), serum albumin competition, and complement activation.
• Many components overlap with those found in anaphylactic reactions.

Conclusions:

• ASA and NSAID hypersensitivity reactions are complex and likely involve multiple interacting mechanisms.
• A single mechanism cannot explain all observed reactions.
• Accurate diagnosis is crucial for effective management of patients sensitive to ASA and other NSAIDs.