Background and Importance Desensitisation protocols for the treatment of hypersensitivity to acetylsalicylic acid (ASA) consist in the administration of increasing doses of ASA at a set time in order to sensitise the patient to the active substance and initiate a chronic treatment. Hypersensitivity to the drug occurs in a wide range of the population, both in healthy subjects and patients with coronary heart disease. This condition may affect patient compliance to therapy and increase the risk of ischemic events especially in secondary prevention.
Aim and Objectives The aim of the work is obtaining a systematic review of the literature concerning the existing desensitisation protocols. The purpose is to conduct a descriptive analysis of the population and evaluate the effectiveness and safety of the protocol over the short and long term.
Material and Methods A retrospective analysis was conducted on a group of patients treated with Rossini’s protocol,1 an increasing oral administration of ASA to 100 mg in five and a half hours.
Results The literature's review has shown the Rossini’s protocol has the greatest number of sample and the best efficacy and safety data. The retrospective analysis allowed the evaluation of the group composed of 30 patients aged > 18 years, admitted to the centre between January 2020 and April 2022, diagnosed with coronary artery syndrome. 83.33% reported a history of hypersensitivity to ASA, especially with skin manifestations (n=8). The most sensitive patients received pre-medication before undergoing the procedure; despite treatment, 20% developed mild adverse reactions. At discharge 73.33% of patients were treated with an antiplatelet therapy of which 77.27% with ASA. 50% of the patients underwent a follow-up, which took place on average after 6 months; upon re-evaluation 60% were on treatment with ASA.
Conclusion and Relevance The evidence suggests that the Rossini’s protocol is effective for a wide spectrum of patients. The hospital pharmacist in agreement with the cardiologist will evaluate the possibility to implement a solution-based formulation to treat more fragile patients, who present history of allergy to ASA, dysphagia or requiring interventional procedures.
R. Rossini, et al, Aspirin desensitization in patients with coronary artery disease: results of the multicenter ADAPTED registry, Circ Cardiovasc Interv, 2017;10.
Conflict of Interest No conflict of interest
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