Rapid and sequential desensitization to both aspirin and clopidogrel

Hypersensitivity reactions to aspirin and clopidogrel are 2.5% and 1%, respectively. Dual anti-platelet therapy with these drugs is effective in preventing thrombosis following deployment of stents for cerebrovascular and cardiovascular syndromes. Desensitization therapy with both aspirin and clopidogrel may be required for patients undergoing stent implantation that have experienced hypersensitivity to these agents. We report the case of a 58-year-old woman who developed urticaria and angioedema following aspirin therapy for ischaemic cerebrovascular disease. She developed an identical reaction after clopidogrel was subsequently administered. Investigations revealed the presence of an internal carotid artery aneurysm that required deployment of a stent. Rapid desensitization to aspirin over 5.5 h followed 3 days later by rapid desensitization to clopidogrel over 2.5 h was successfully performed prior to stenting. After 4 months she has tolerated this dual anti-platelet therapy without any adverse reaction. Rapid and sequential desensitization to both aspirin and clopidogrel can be successfully performed for patients who require stent deployment but have hypersensitivity to both these anti-platelet agents.