Adverse reactions to aspirin and nonsteroidal antiinflammatory drugs (NSAIDs)

Background Aspirin can provoke reactions ranging from respiratory to cutaneous in those susceptible individuals. There has been particular attention looking at the role of cyclo-oxygenase enzymes and 2 and their role in aspirin exacerbated respiratory disease. Objective Patients who present with a spectrum of allergic and pseudoallergic reactions to aspirin pose a special challenge for the physician. This article discusses proposed classification system, clinical manifestations, pathogenesis of disease, and current treatment options of aspirin related disease. Methods Relevant articles in the medical literature were, derived from searching the MEDLINE database. Soures also include review articles, randomized control trials, and standard textbooks of allergy and immunology. Results Aspirin-exacerbated respiratory disease remains a complex, heterogenous disease with manvaried clinical presentations. There have been many advances in trying to elucidate the pathogenesis of this disease. The classification system presented will provide greater ease when reading the literature and communicating with one another. Oral aspirin challenge remains the diagnostic test of choice for both respiratory and cutaneous reactions. Aspirin desensitization is an option for those with refractory respiratory diuease or who require aspirin for other medical conditions. Conclusions This review discusses the challenges in classification, diagnosis and treatment of those patients with a sensitivity to aspirin. Special attention is made to the possible mechanisms mediating disease progression and how specific. Therapies, such as the leukotriene modifiers may be helpful.