Aspirin Allergy: What are NSAIDs?Non-Steroidal Anti-Inflammatory Drugs (abbreviated NSAID) include a large number of medications that are closely related to aspirin. Aspirin was the first NSAID discovered in the 1800’s, isolated from the bark of the willow tree. Today hundreds of chemically produced NSAIDs are used to control conditions that involve inflammation, pain, and fever.
What types of allergic reactions occur to aspirin and other NSAIDs?Many different reactions have been reported, from mildly bothersome to life threatening. The most common reactions include:
These “allergic” reactions are distinct from other “adverse effects” such as stomach upset, bleeding, or bruising that are also commonly reported with NSAIDS but not considered allergic in nature. Find out more about the differences between drug allergy and intolerance.
How common is NSAID allergy?NSAID allergy is estimated to be present in approximately 1% of the general population. In patients with asthma, approximately 10% may have their asthma symptoms worsened by NSAIDS. If a person with asthma also has chronic sinusitis/nasal polyps, the chance of NSAID allergy increases to 40 percent.
In patients with chronic hives and/or swelling, NSAIDs may worsen skin reactions. NSAIDs are also a trigger for some patients with anaphylaxis, aseptic meningitis, hypersensitivity pneumonitis, and other reactions, although the absolute risk is unclear.
Can I be tested for NSAID allergy?Unlike allergic reactions to pollens, animal dander and foods, in which there are allergic antibodies (IgE) against the trigger, reactions to aspirin and other NSAIDs generally do not occur as a result of IgE. Therefore, allergy testing is not usually of benefit. In some cases, an oral challenge may be performed under the supervision of an allergist to evaluate for sensitivity or tolerance to a specific NSAID.
How is NSAID allergy treated?Avoidance of all of the NSAIDs is the usual treatment for NSAID allergy. It is important to be aware of the huge variety of medications that contain aspirin or related NSAIDs. In addition to avoidance, it is also recommended that NSAID-allergic patients wear a Medic-Alert® bracelet to notify emergency personnel of their condition in the event they are unable to communicate.
In some situations, such as certain medical conditions, an NSAID is a required therapy. For these people a desensitization procedure is a possible treatment, and should only be performed by allergy physicians skilled in the desensitization of drugs. Desensitization to NSAIDs may be successful for patients with respiratory-NSAID allergy or anaphylaxis, but does not work for skin-NSAID allergy.
What drugs should be avoided by a person with NSAID allergy?The following are the most commonly used NSAIDs that should be avoided by NSAID-allergic patients. This list is in no way comprehensive - always talk with your doctor or pharmacist before taking any new prescription or over-the-counter medications.
Prescription medications to avoid.
- 1. Diclofenac (Voltaren®)
- 2. Diflunisal (Dolobid®)
- 3. Etodolac (Lodine®)
- 4. Fenoprofen (Nalfon®)
- 5. Flurbiprofen (Ansaid®)
- 6. Ibuprofen (Motrin® products, Advil® products, many generic forms)
- 7. Indomethacin (Indocin®)
- 8. Ketoprofen (Orudis®)
- 9. Ketorolac (Toradol®)
- 10. Meloxicam (Mobic®)
- 11. Nabumetone (Relafen®)
- 12. Naproxen (Aleve®, Naprosyn®, Anaprox® products)
- 13. Oxaprozin (Daypro®)
- 14. Piroxicam (Feldene®)
- 15. Salsalate (Disalcid®)
- 16. Sulindac (Clinoril®)
- 17. Tolmetin (Tolectin® products)
Over-the-counter medications to avoid.
- 1. Alka-Seltzer®
- 2. Anacin®
- 3. Aspirin
- 4. Bayer®
- 5. Bufferin®
- 6. Doan’s®
- 7. Dristan®
- 8. Ecotrin®
- 9. Excedrin®
- 10. Goody’s®
- 11. Kaopectate®
- 12. Norwich®
- 13. Pamprin®
- 14. Pepto-Bismol®
- 15. Sine-Off®
- 16. St. Joseph's®
What drugs are “safe” in a person with NSAID allergy?Except in extremely rare cases, Tylenol® (acetaminophen) is safely tolerated and is considered the drug of choice in NSAID-allergic patients. The newer COX-2 inhibitors, available only as celecoxib (Celebrex®) in the United States at present, are usually tolerated as well, although it is recommended that patient be monitored in a physician’s office for the first full dose of these medications. Most narcotics are safe, with the exception of some combination products containing NSAIDs.
It is recommended that any person with a known or suspected NSAID allergy consult with their physician or allergist before using any product that may be related to NSAIDs.
Namazy JA, Simon RA. Sensitivity to Nonsteroidal Anti-inflammatory Drugs. Ann Allergy Asthma Immunol. 2002;89:542-50.
Stevenson DD, Szczeklik A. Clinical and Pathologic Perspectives on Aspirin Sensitivity and Asthma. J Allergy Clin Immunol. 2006;118:773-86.
DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.