Aspirin allergy and Ibuprofen

DustinfromCA said:

Is there a % range established regarding the cross-sensitivity between aspirin and ibuprofen? Say if a doctor prescribes ibuprofen for a patient with a salicylate allergy and he responds by saying there is a slim chance there will be a cross reaction.. what is that number?

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If I remember correctly if someone as a true allergy to aspirin there is a 90% chance of crossensitivity reaction to NSAIDS.

COX-2 inhibitors have not demonstrated cross-reactivity in patients who have the aspirin-induced bronchospasm (is that the particular reaction that this patient had? Or was it a skin reaction?) So if this is short-term use, you could recommend changing to celecoxib if the patient has no cardiovascular risk factors and their insurance covers it. In theory, meloxicam would then have a lower risk of causing the allergy than ibuprofen, but I didn't see any data backing this up (very hard to do literature searches on an iPhone lol).

So my question for the pharmacists out there is: if you documented that you warned the physician and they told you to fill it, and you documented that you counseled the patient and they understood the risks/benefits and yet they still decided to try it, would you be in legal trouble if the patient developed the reaction and died or had an ED visit, even though you warned all parties and they still decided that the benefits were greater than the risks?

DustinfromCA said:

so then it would be an absolute contraindication with ibuprofen. This is a general real-life practice type of question. If doctor OKs to go ahead and fill despite the allergy, do you fill or not fill?

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You need to try to ascertain what the allergic reaction was.

Pharmacist: Are you allergic to aspirin?
Patient: Yes
Pharmacist: What happened when you took aspirin?
Patient: It gives me a stomach ache?

In this case, dispense away. If the patient as asthma, urticaria or nasal polyps or has had a severe allergic reaction to aspirin, I would avoid NSAIDS and recommend a COX-2 inhibitor....

Technically, I believe there is an increased risk of patients with an NSAID allergy also having a salicylate allergy. It's not a "cross-sensitivity" which would mean that the two agents trigger the same allergy.

What about naproxen (alleve)? Is there a common cross-sensitivity with naproxen in people allergic to ibuprofen?

gadlo said:

What about naproxen (alleve)? Is there a common cross-sensitivity with naproxen in people allergic to ibuprofen?

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What class is ibuprofen? And what about naproxen?

gadlo said:

What about naproxen (alleve)? Is there a common cross-sensitivity with naproxen in people allergic to ibuprofen?

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You serious?

BenJammin said:

You serious?

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This

As suggested, ascertain that its a true allegy. People will say they are allergic to a medicine because it upsets their stomach, or for the most bizarre reasons. Also, ascertain if the person has ever had ibuprofen (most likely they have, under a brand or store brand name) If they have never had it before & they've had a true allergy to aspirin....it's a judgement call on whether to fill--age of patient & diagnosis are 2 things to consider. Also, does the patient live alone, would they have quick access to help if they did have an allergic reaction? I've given prescriptions back to patients and told them I didn't feel comfortable filling the prescription (and why), I've also filled questionable prescriptions after talking to the dr and (s)he had a sensible reason on why that RX was needed (and then documented.) There aren't easy answers.

BenJammin said:

You serious?

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Don't be a jerk. I didn't write this to work on my typing skills. This is a serious question.

It is common to have hypersensitivity reactions across drug classes. However, a lot of drugs across a class have very similar structures. Naproxen looks a bit different than the other NSAIDs. I was wondering about the mechanism underlying hypersensitivity reactions across drug classes. Is it due to a immune response towards a specific epitope of the drugs? Is it target related? Is it an off-target related effect?

gadlo said:

Don't be a jerk. I didn't write this to work on my typing skills. This is a serious question.

It is common to have hypersensitivity reactions across drug classes. However, a lot of drugs across a class have very similar structures. Naproxen looks a bit different than the other NSAIDs. I was wondering about the mechanism underlying hypersensitivity reactions across drug classes. Is it due to a immune response towards a specific epitope of the drugs? Is it target related? Is it an off-target related effect?

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Did you just get out of immuno? If a person had a serious reaction to ibuprofen, you being a health care professional, should probably ensure the patient stays away from NSAIDs and not worry about the epitopes.

gadlo said:

Don't be a jerk. I didn't write this to work on my typing skills. This is a serious question.

It is common to have hypersensitivity reactions across drug classes. However, a lot of drugs across a class have very similar structures. Naproxen looks a bit different than the other NSAIDs. I was wondering about the mechanism underlying hypersensitivity reactions across drug classes. Is it due to a immune response towards a specific epitope of the drugs? Is it target related? Is it an off-target related effect?

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You are not going pull a switch like that on me. Your question was

What about naproxen (alleve)? Is there a common cross-sensitivity with naproxen in people allergic to ibuprofen?

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and my response was appropriate. A pharmacy student should NOT be asking a question like that.

BenJammin said:

You are not going pull a switch like that on me. Your question was



and my response was appropriate. A pharmacy student should NOT be asking a question like that.

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Nice try. Look at the structure of naproxen and compare it to aspirin and ibuprofen. It is fairly different (two substituted benzene rings vs. one). Get off your high horse and stop assuming you can read minds. You are trying to backpedal and reaffirm your position to save face because you know your response was not cool.

Let me rephrase my question then. What is the mechanism underlying hypersensitivity reactions across classes of drugs? Is it a target effect? Is it an off target effect? Is it related to an immune response toward a shared structural similarity between the drugs of that class (in which case, different looking drugs may not cause a reaction)?

gadlo said:

Nice try. Look at the structure of naproxen and compare it to aspirin and ibuprofen. It is fairly different (two substituted benzene rings vs. one). Get off your high horse and stop assuming you can read minds. You are trying to backpedal and reaffirm your position to save face because you know your response was not cool.

Let me rephrase my question then. What is the mechanism underlying hypersensitivity reactions across classes of drugs? Is it a target effect? Is it an off target effect? Is it related to an immune response toward a shared structural similarity between the drugs of that class (in which case, different looking drugs may not cause a reaction)?

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It depends

SO what is the consensus of this discussion?

If a pt presents with a h/o of aspirin hypersensitivity or allergy, we should not prescribe any other NSAID (not even Cox-2 inhib) ???

Be very specific when asking about medication allergies, particularly with over the counter medications. A typical answer for penicillin allergy is "I got it when I was four and I threw up." Allergy or normal four year old reaction to being sick and getting medication. With regard to over the counter aspirin and NSAIDs, ask the follow up questions. Most patients have already done the 'oral challenge' for over the counter pain relievers and will be able to tell you that 'it upsets my stomach' or 'I got hives and had trouble breathing'. Many reactions to NSAIDs are drug specific and not class specific as with cephalosporin antibiotics, for instance. So ibuprofen may be a problem but naproxen may not. Also, be sure to rule out Samter's triad in the case of aspirin allergy. When I work with trainees in particular, I stress that the patient will be able to answer these questions and solve you dilemma.

Me: I see that you are allergic to aspirin. What happens when you take it?
Patient: It upsets my stomach
Me: Have you ever taken ibuprofen (Motrin) or naloxone (Aleve)?
Patient: Yes
Me: Does ibuprofen give you any problems?
Patient: No

I would handle the situation in this way:
Try to call the patient first to get them to explain the ASA allergy.
Then one of three things happen: 1) they have a BS allergy (like everyone has pointed out = tummy upset) so then it gets filled.
2) If they don't know or don't answer I'd call the MD and have them double check the patient's chart there for any allergy details and ask if they want you to dispense. If they say yes, document this and make a note on the bag to have the patient talk to the pharmacist at the time of pick up.
3) if they say they had a true salicylate allergy with wheezing, angioedema, bronchospasm, etc then I would not dispense, call the MD and explain, tell them you are NOT dispensing the med even if they say to, document this, and if the patient gets mad and wants to buy it OTC at their own risk then great.
I wouldn't fill ANY NSAID's for them in this case just to make sure your butt is covered. If a person has a true aspirin allergy they probably will be happy to not take a chance on taking any NSAIDs.

Just ask them if they've taken Advil before. 99% chance they have and your problem is solved.

aynsof said:

Me: I see that you are allergic to aspirin. What happens when you take it?
Patient: It upsets my stomach
Me: Have you ever taken ibuprofen (Motrin) or naloxone (Aleve)?
Patient: Yes
Me: Does ibuprofen give you any problems?
Patient: No

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This. Except I think you mean naproxen not naloxone