Aspirin allergy in patients with myocardial infarction: the allergist's role.

Drug hypersensitivity can preclude patients from receiving the drug of choice to treat a specific illness. In some cases, such as penicillin allergy in a pregnant woman with syphilis,1 the drug is clearly indicated, and allergists may be called on to induce temporary drug tolerance (desensitize). In other cases, the medication benefit is not as clear, and allergists must weigh desensitization (DS) risks against the risks and benefits of alternative medications. For aspirin (ASA) hypersensitivity, a significant amount of literature has been published addressing scenarios in which patients with aspirin-exacerbated respiratory disease (AERD) are desensitized to ASA, but little has been published to address the issue of ASA hypersensitivity in patients with other types of ASA hypersensitivity andmyocardial infarction (MI). Of the protocols for these patients that have been published, none have been prospectively randomized, validated, or clearly documented to alter the immune system, making the diagnosis and treatment pathway unclear at times. ASA is clearly of benefit in patients with ST-segment elevation MI (STEMI) or non-STEMI.2 In patients who tolerate ASA, ASA therapy is expected; other antiplatelet agents are additions, not substitutions.3 In the era of dual antiplatelet therapy, allergists can offer cardiology colleagues a valuable service if called on to evaluate patients reporting ASA hypersensitivity.