[Desensitization to Acetylsalicylic Acid in patients with coronary artery disease]

A 77-year-old male patient with a history of facial angioedema 20 years prior after ingesting 500 mg of acetylsalicylic acid (ASA). In 2024, he underwent angioplasty with coronary stenting without ASA. He was admitted to the emergency department with chest pain. Coronary angiography confirmed acute myocardial infarction requiring stenting and repositioning. The catheterization department recommended triple therapy with clopidogrel, anticoagulant, and ASA. Due to the history of adverse reactions, a consultation was requested to assess tolerance to ASA. An oral challenge/desensitization was performed. Prior to the procedure, he presented with a peak expiratory flow (PEF) of 450 L/min, normal vital signs (VS), and a 5-point clinical score. ASA was administered every 15 minutes in progressive doses of 10 mg, 32 mg, 85 mg, and 174 mg, until reaching a cumulative dose of 301 mg. PEF, SV, and EC were monitored every 15 minutes for up to 4 hours after the start of treatment, with no changes. The following day, a loading dose of 300 mg of ASA was administered prior to coronary catheterization, followed by a maintenance dose of 100 mg/d.

Various desensitization regimens exist. Khan proposes a regimen with 90-minute intervals using doses of 40.5 mg, 81 mg, 162 mg, and 325 mg. In our case, reducing the intervals to 15 minutes facilitated desensitization in a shorter time, which is useful in cardiac emergencies. Desensitization allowed tolerance to the loading dose prior to cardiac intervention and the maintenance dose without adverse reactions.