Aspirin Allergy, Asthma and Polyps

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15 percent of all asthma patients and 40 percent of asthmatics with nasal polyps are allergic to aspirin and other NSAID’s (e.g., Advil, Aleve, Motrin). Often, they need repeated sinus surgeries and oral steroids for asthma. In 1979, researchers showed that desensitizing them to aspirin results in fewer asthma flares, increased sense of smell, and fewer surgeries. For desensitized patients, the need for sinus surgery drops from once every three years to once every ten years.

We also get aspirin allergy referrals from cardiologists. Cardiac stents that could save a patient the risk of open heart surgery recommend that you take aspirin afterwards to keep the stent open. Here’s the thanks from one cardiologist: “You just saved this lady cardiac bypass surgery. Not bad for an allergist.” Arthritis patients often cope better with pain if they can take NSAID’s. When they are allergic to aspirin, it limits their options.

There are two completely distinct ways to be allergic to aspirin. Aspirin triggers asthma and sinus disease in some people, and hives in others. Aspirin desensitization usually takes two days, but then you must continue to take aspirin twice per day to remain desensitized.

In February 2011, a patient drove to Houston from Michigan to get desensitized for his aspirin exacerbated respiratory disease by The Allergy Clinic. He couldn’t smell, had already had six sinus surgeries and often needed steroids for asthma. He found us on the Internet and left his email with our nurses. Emailing back, I asked why he would drive right by Chicago and Memphis to go to Houston since those medical centers perform aspirin desensitization. Or why not go to Scripps Clinic in San Diego where they pioneered this 30 years ago. His answer: I can’t get those guys to answer all my questions the way you have. He probably meant to say that Houston is a much prettier place to visit than La Jolla.

David B. Engler, MD

Note: Information contained in this article should not be considered a substitute for consultation with a board-certified allergist to address individual medical needs.