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Aspirin sensitivity: acetylsalicylate or excipients
1Pharmaceutical Services Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham, UK. hebron@swbh.nhs.uk
Internal Medicine Journal
|September 8, 2009
Summary
Hypersensitivity reactions to enteric-coated aspirin, specifically urticaria, were observed in three patients. These reactions may be linked to pharmaceutical excipients rather than aspirin itself, even without prior atopy.
Area of Science:
- Pharmacology
- Clinical Medicine
- Allergy and Immunology
Background:
- Hypersensitivity reactions to aspirin (acetylsalicylate) are documented, particularly in individuals with asthma or nasal polyps.
- Standard hypersensitivity assessments often focus on the active pharmaceutical ingredient.
Observation:
- Three patients developed urticaria upon taking an enteric-coated aspirin formulation, with reactions confirmed by re-exposure.
- These patients lacked a history of atopy.
- Two patients tolerated a soluble aspirin formulation, suggesting formulation-specific sensitivity.
Findings:
- The observed urticaria reactions appear linked to the enteric formulation of aspirin.
- The possibility of hypersensitivity to pharmaceutical excipients in the enteric coating is suggested.
- This contrasts with typical aspirin hypersensitivity, which is usually attributed to acetylsalicylate.
Implications:
- This case series highlights the potential for adverse reactions to pharmaceutical excipients, even in low-dose formulations.
- It suggests a need to consider excipient-related allergies in unexplained drug hypersensitivity reactions.
- Further investigation into excipient-specific hypersensitivity is warranted for clinical diagnosis and patient management.
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