Aspirin allergy

Introduction Aspirin allergy refers to allergic reactions such as rash, angioedema and asthma after taking aspirin, which is more common in middle-aged people or rhinitis and nasal polyps.

Cause

This is because aspirin inhibits the formation of a large amount of allergic media by another route after the cyclooxygenase is released.

Aspirin allergy symptoms:

1. More common gastrointestinal reactions such as nausea, vomiting, upper abdominal discomfort or pain.

2. Less common or rare are:

(1) gastrointestinal bleeding or ulcers, manifested as bloody or tar-like stools, severe pain in the stomach or vomiting blood or coffee-like substances, more common in patients taking large doses.

(2) bronchospasm allergic reaction, manifested as difficulty breathing or asthma.

(3) skin allergic reaction, manifested as rash, urticaria, itchy skin and so on.

(4) Hematuria, dizziness and liver damage.

an examination

In clinical patients who are allergic to aspirin, first check the patient's allergy history, determine whether the cause of aspirin allergy is caused by physical factors; second, according to the symptoms of aspirin allergy, check the nature, color, itching of the rash, check asthma The duration and accompanying symptoms; three blood, urine routine examination, allergen examination, etc., to determine the cause and severity of trichiasis, provide the basis for the next treatment.

Differential diagnosis

Differentiation from other aspirin-induced adverse reactions:

1, gastric mucosal injury

Aspirin can cause gastric mucosal erosion, bleeding and ulcers. Most patients take a moderate dose of aspirin for several days, that is, the fecal occult blood test is positive; the long-term use of this drug has a high incidence of ulcer disease. I have encountered 1 patient with high fever oral aspirin 0.6g / time, 2 times a day, 3 days after hematemesis 500ml. Injectable drugs can also occur in addition to the acidity of the drug directly causing damage to the gastric mucosa. Aspirin can penetrate the gastric mucosal epithelial lipoprotein membrane to destroy the protective effect of lipoprotein membrane, so that gastric acid reversibly diffuses into the damaged cells in the tissue, causing capillary damage and bleeding. Recently, prostaglandins have been found to have a certain effect on the maintenance of gastric mucosa, and aspirin has been shown to prevent the synthesis of prostaglandins, increase the epithelial detachment of the gastric mucosa and exceed the renewal rate, increase the degree of ulceration, and reduce gastric mucus. For this reason, it is best to take aspirin or take it with antacids when applying aspirin. Patients with ulcer disease should be used with caution or not.

2, liver damage

Liver damage caused by aspirin has been reported in the country less. There are data showing that when the serum aspirin concentration decreases, the transaminase also returns to normal. Drug-induced liver damage may be associated with hepatotoxic or allergic reactions.

3, hemorrhage, hemolysis, hematopoietic dysfunction

Aspirin has the function of dilating coronary artery and cerebrovascular disease, failing to inhibit the synthesis of prothrombin in the liver, inhibiting the activity of cyclooxygenase and reducing the formation of thrombin A2, preventing platelet aggregation, making it difficult to release clotting factors, and having certain Anticoagulant effect. For this reason, those with gastrointestinal bleeding or ulcer disease, who have a tendency to hemorrhage clinically or who have a history of cerebral hemorrhage in the near future should not take this medicine. Pregnant women take aspirin, and brain damage such as cerebral hemorrhage often occurs in premature infants. Therefore, pregnant women should stop using this product 2 to 3 months before delivery. Aspirin can cause hematopoietic dysfunction. The author has seen 1 case of patients with acute hematopoietic stagnation caused by taking this product. It is itchy after 4 hours of taking this product. After 7 hours, the nose and gums are bleeding, accompanied by whole body purpura. The bone marrow is obviously inhibited by the red blood cell line. After symptomatic treatment, The bone marrow returned to normal after 10 days. Aspirin can cause hemolysis.

4, kidney damage

Clinical observation and animal experiments have shown that long-term use of aspirin can cause interstitial nephritis, renal papillary necrosis, and renal dysfunction. Long-term use of this product can cause oxidative phosphorylation and decoupling. Potassium is excreted from the renal tubular cells, resulting in potassium deficiency and uric acid excretion in the urine. The larger damage is protein, cells and casts in the lower urine.

5, neuropsychiatric symptoms

When using anti-rheumatic dose, the so-called salicylic acid reaction sometimes occurs in the first 3 to 4 days of treatment. Symptoms include headache, dizziness, tinnitus, and hearing loss. When the dosage is too large, mental confusion, convulsions, and even coma may occur. . Symptoms of clinical manifestations include rash, angioedema, and asthma.

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