aspirin hypersensitivity - NSAID's contraindicated

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tarsuc

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So if a patient presents with h/o of aspirin allergy or HS,

it it true that no other NSAID (even COX-2 inhib) can be prescribed?

(due to cross hypersensitivity between Aspirin and other NSAIDS)

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So if a patient presents with h/o of aspirin allergy or HS,

it it true that no other NSAID (even COX-2 inhib) can be prescribed?

(due to cross hypersensitivity between Aspirin and other NSAIDS)

If someone's got an aspirin allergy, it means that he or she is sensitive to any form of leukotriene overproduction (diagram in FA illustrates well how COX inhibition shuttles substrates to the leukotriene pathway).

I would assume that irreversible inhibition with aspirin would be the worst, followed by that seen with a reversible, potent NSAID (e.g. indomethacin), then possibly, last on the list, that seen with a COX-2 inhibitor.

I've never heard of specifically not prescribing an NSAID to a person who's had a history of aspirin-induced asthma or HS / rash, but it just makes sense that you wouldn't.

For instance, if a 68F diabetic with malignant otitis externa (i.e. P. aeruginosa) has had a Hx of penicillin allergy, you probably wouldn't want to give her ceftazidime, knowing that she could be allergenic (10%), when you could just give her aztreonam.

If someone has a Hx of aspirin allergy, don't give an NSAID. It's just better medicine.
 
If someone's got an aspirin allergy, it means that he or she is sensitive to any form of leukotriene overproduction (diagram in FA illustrates well how COX inhibition shuttles substrates to the leukotriene pathway).

I would assume that irreversible inhibition with aspirin would be the worst, followed by that seen with a reversible, potent NSAID (e.g. indomethacin), then possibly, last on the list, that seen with a COX-2 inhibitor.

I've never heard of specifically not prescribing an NSAID to a person who's had a history of aspirin-induced asthma or HS / rash, but it just makes sense that you wouldn't.

For instance, if a 68F diabetic with malignant otitis externa (i.e. P. aeruginosa) has had a Hx of penicillin allergy, you probably wouldn't want to give her ceftazidime, knowing that she could be allergenic (10%), when you could just give her aztreonam.

If someone has a Hx of aspirin allergy, don't give an NSAID. It's just better medicine.

In real life you don't contraindicate all cephalosporins because of a penicillin allergy. The 10% figure is a myth. Several studies have shown that people allergic to penicillin are at no greater risk of anaphylaxis with cephalosporins than people who are non-allergic to penicillins.

You'd start with broad spectrum antibiotics and then narrow it based on culture, sensitives and her renal/liver function. That may indicate aztreonam, or it may not.

In case you'd like to read more about it:
http://www.jfponline.com/pages.asp?aid=3850
 
In real life you don't contraindicate all cephalosporins because of a penicillin allergy. The 10% figure is a myth. Several studies have shown that people allergic to penicillin are at no greater risk of anaphylaxis with cephalosporins than people who are non-allergic to penicillins.

You'd start with broad spectrum antibiotics and then narrow it based on culture, sensitives and her renal/liver function. That may indicate aztreonam, or it may not.

In case you'd like to read more about it:
http://www.jfponline.com/pages.asp?aid=3850

Aminoglycosides and aztreonam both target aerobic gram(-) bacilli (as you know), but the latter is used in patients with possible renal insufficiency, which includes our 68F diabetic.

I just couldn't imagine consciously giving a penicillin-allergenic pt a ceph, ever, despite what some studies may have revealed about a 10% "myth," especially since there are other drugs that are equally effective. If you give the ceph and he or she reacts, it just looks kind of silly/unprofessional given that you knew she had the Hx of allergy.
 
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You'll get used to it. In the real hospital setting penicillin allergic patients are routinely given 2nd and 3rd generation cephalosporins. If you're in the ER and a patient comes in with meningitis, you're not going to hold ceftriaxone + vancomycin because of a past penicillin allergy, especially if it was merely a rash. The equally effective alternative that's indicated in this case would be chloramphenicol and I've yet to see a single doctor write an order for it.
 
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For instance, if a 68F diabetic with malignant otitis externa (i.e. P. aeruginosa) has had a Hx of penicillin allergy, you probably wouldn't want to give her ceftazidime, knowing that she could be allergenic (10%), when you could just give her aztreonam.

Actually it is more like 1%. FA is wrong there. I looked it up after Dr. Conrad Fisher took it upon himself to add more corrections to the FA.
 
You'll get used to it. In the real hospital setting penicillin allergic patients are routinely given 2nd and 3rd generation cephalosporins. If you're in the ER and a patient comes in with meningitis, you're not going to hold ceftriaxone + vancomycin because of a past penicillin allergy, especially if it was merely a rash. The equally effective alternative that's indicated in this case would be chloramphenicol and I've yet to see a single doctor write an order for it.

I agree (although I have seen quite a few chloramphenicol orders). There are other things besides the spectrum that one needs to consider. Stuff like cost, availability, attending's comfort in using the particular medication, etc.
 
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