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Prevalence and management of aspirin hypersensitivity in a cardiology practice
Gabriela M Orgeron1, Ruby Havistin1, Laura S Hahn1
1From the Medstar Union Memorial Hospital, Baltimore, Maryland, and.
Insights
Aspirin (ASA) hypersensitivity affects 1.88% of patients, often misdiagnosed or mismanaged. Improved clinical strategies are needed for accurate diagnosis and treatment, including desensitization.
Area of Science:
- Cardiology
- Clinical Immunology
- Pharmacology
Background:
- Limited data exists on aspirin (ASA) hypersensitivity prevalence and management.
- Cardiology practices require better understanding of ASA hypersensitivity.
Purpose of the Study:
- To determine the prevalence of ASA hypersensitivity.
- To classify reaction types and assess clinical management implications in cardiology.
- To evaluate diagnostic accuracy and treatment strategies for ASA hypersensitivity.
Main Methods:
- Retrospective electronic medical record review of 11,375 patients (ambulatory and percutaneous coronary intervention settings).
- Data collected from January 2012 to December 2013.
- Analysis of documented hypersensitivity reactions, misdiagnoses, and discharge medications.
Main Results:
- ASA hypersensitivity prevalence was 1.88% (214 patients).
- Skin reactions (19%) were most common, followed by angioedema (4.6%), respiratory (4.2%), and anaphylaxis (2.8%).
- 34.5% of records were missing, and 32.2% were misdiagnosed with gastrointestinal symptoms; 50.46% of affected patients had coronary artery disease.
Conclusions:
- ASA hypersensitivity is frequently misdiagnosed, under-documented, or mismanaged.
- There is a critical need for improved management protocols, including desensitization and avoiding unnecessary avoidance.
- Accurate diagnosis and appropriate management are essential for patients with ASA hypersensitivity, particularly those with cardiovascular conditions.
Abstract:
Background: Data are lacking with concern to the prevalence and management of aspirin (ASA) hypersensitivity. Objective: To study the prevalence, different types of reactions, and implications for clinical management of ASA hypersensitivity in a cardiology practice. Methods: We conducted an electronic medical record review of 11,375 individuals, 5052 (44%) in the ambulatory setting, and 6323 (56%) admitted for percutaneous coronary intervention (PCI), from January 2012 to December 2013. Results: The prevalence of ASA hypersensitivity was 1.88% (n = 214). Skin reactions were the most common (40 [19%]), followed by angioedema (10 [4.6%]), respiratory (9 [4.2%]), and anaphylaxis (6 [2.8%]). No records were found for 74 patients (34.5%), and 69 patients (32.2%) were mistakenly labeled as allergic for having gastrointestinal symptoms. Of the 214 patients who had documented ASA hypersensitivity, 108 individuals (50.46%) had coronary artery disease. The medications at discharge were the following: ASA (30 [14%]), thienopyridine (48 [22%]), a combination of ASA and thienopyridine (13 [6%]), anticoagulation only (26 [12%]), and no antiplatelet (97 [43%]). Conclusion: ASA hypersensitivity is often not documented correctly or is often misdiagnosed or not appropriately managed. There is a need for improved management of ASA hypersensitivity, including appropriate referral for ASA desensitization and combating unnecessary avoidance in patients with intolerance due to adverse effects.
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