Board Certified Periodontist, Dr. Scott O. Kissel

Drug Allergies

Patient Discussing All-On-4 Dental Implant with Periodontist

Table of Contents

Should all NSAIDS be avoided in patients with aspirin reactions?

Most aspirin and NSAID reactions AREN’T immune-mediated or TRUE allergies.  Most are sensitivities due to inhibition of COX-1 which triggers leukotriene productions…leading to bronchospasm, hives, etc.

Patients with aspirin sensitivity are usually also sensitive to NONselective NSAIDS such as ibuprofen, naproxen, ketorolac, etc.  Avoid nonselective NSAIDS in these patients. Consider these alternatives for patients with aspirin sensitivity.

Acetaminophen or salsalate weakly inhibit COX-1 but cross-sensitivity with aspirin usually isn’t a problem at a lower dose.  Try up to 650mg/dose of acetaminophen and 1500mg/dose of salsalate for people with aspirin sensitivity.

Celecoxib (Celebrex) prescribing info discourages using it in patients with aspirin sensitivity.  But cross-sensitivity is rare..because it’s COX-2  selective.

Meloxicam (Mobic, etc) is COX-2 selective at low doses but loses selectivity at high doses.  Try up to 7.5 mg/day for meloxicam.

Consider giving the first dose of these alternatives in your office in case there’s a reaction or refer patients to an allergist.

Occasionally a reaction to aspirin is immune-mediated.  In this case, it’s usually okay to use an NSAID because its chemical structure is different from aspirin.

The problem is that it’s hard to distinguish between aspirin sensitivity and a true allergy.  When in doubt, refer these patients to an allergist for evaluation.

Curr Allergy Asthma Rep 2009;9:155

More Posts


Benefits of Laser Dentistry

Benefits of Laser Dentistry in NYC Explore Advanced Gum Treatments At NYC Periodontics and Implant Dentistry Laser dentistry is changing how we think about dental

Book A Consultation

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.