Background: Intolerance to acetylsalicilic
acid (ASA) and nonsteroidal antiinflammatory
drugs (NSAIDs) is a crucial problem in
medical practice. The prevalence of NSAIDs
intolerance is estimated as 0.6\u20132.5 in the
general population, rising to over 10\u201320% in
asthmatic patients. In general practice,
NSAIDs are always supposed to cross-react
with each other. Because the use of ASA as
platelet antiaggregant is mandatory in many
cardiological diagnostic and therapeutic
procedures, ASA intolerance is a common
and a severe problem in Coronary Intensive
Care Unit (CICU). Here we describe the
case of a Diclofenac intolerant patient who
tolerates ASA treatment without any reaction.
Case Report: A 57 years old male patient,
affected with mild hypertension and osteoarthritis
suffered a severe anaphylaxis
after the application of a Diclofenac suppository.
A few minutes after the drug
application he had symptoms of glottis
oedema and rapidly fell unconscious. The
rescue team found him pulseless. He underwent
to resuscitation procedures with success.
Then, he was admitted into the CICU
and the tests performed there showed: nonspecific,
diffused alterations of the repolarization
(DII, DIII; V3-V6) at the electrocardiogram;
a mild increment of troponine I
(maximum 3.17 mg/L); no pathological findings
at the echocardiography. The ventricular
coronarography showed a 95% stenosis
of a collateral vessel of the right coronary
artery that underwent to a successful placement
of a drug-eluting stent. Chest X-Ray,
ultrasound scans of the abdomen and of the
chest, and brain Computer Tomography
were normal. When he was in CICU he
was started on therapy with ASA 100 mg
daily under medical control. He tolerated
ASA without any complication during all
the eleven days of hospitalization. The
allergy consultant suggested to avoid stopping
the therapy with ASA and to avoid
taking Diclofenac, Aceclofenac and any
other NSAIDs, apart from paracetamole in
the future. This case demonstrates that
patients with severe Diclofenac hypersensitivity
could tolerate other NSAIDs, in
particular ASA, mandatory in some medical
procedures. Other authors (1) described
tolerance of indomethacin, piroxicam,
methamizole but not ASA in 12 Diclofenac
hypersensitive patients.
Conclusion: In conclusion, patients referring
previous reactions to NSAIDs should not be
a priori excluded from treatment requiring
ASA
