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Asthma and Pain Relievers

An information paper for health professionals
Introduction

Key messages

What is ‘aspirin-induced asthma’?
How is aspirin-induced asthma diagnosed?
How is aspirin-induced asthma treated?

What pain relievers can patients with aspirin-induced asthma take?
Pain relievers and children with asthma
Non-prescription analgesics and asthma
Levels of evidence
References

Authors

Disclaimer

Further information
Content created MAR 2005
Content updated MAR 2005

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NextBackLevels of evidence

I           Evidence obtained from a systematic review of all relevant randomised controlled trials
II Evidence obtained from at least one properly designed randomised controlled trial
III-1 Evidence obtained from well-designed pseudo-randomised controlled trials (alternate allocation or some other method)
III-2 Evidence obtained from comparative studies with concurrent controls and allocation not randomised (cohort studies), case-control studies, or interrupted time series with a control group
III-3 Evidence obtained from comparative studies with historical control, two or more single-arm studies, or interrupted time series without a parallel control group
IV Evidence obtained from case series, either post-test or pre-test and post-test  

These levels of evidence ratings have been adapted from US Preventive Services Task Force (1989) Guide to clinical preventive services: an assessment of the effectiveness of 169 interventions (ed M Fisher), Williams and Williams, Baltimore, Appendix A, p 388.

Source: NHMRC
A guide to the development, implementation and evaluation of clinical practice guidelines.

References

1 Medicines Control Agency, UK, October 22, 2002.
2 Stevenson DD, Sanchez-Borges M, Szczeklik A. Classification of allergic and pseudoallergic reactions to drugs that inhibit cyclooxgenase. Ann Allergy Asthma Immunology 2001;87:177-180.
3 Szczeklik A, Nizankowska E, Duplaga M. Natural history of aspirin-induced asthma. Eur Respir J 2000; 16: 432-436.
4 Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis and management. J Allergy Clin Immunol. 1999 Jul;104(1):5-13.
5 Jenkins C, Costello, J, Hodge L. (2003). Asthma and simple over-the-counter analgesics: An evidence-based review of the prevalence of aspirin-induced asthma and its implications for clinical practice. (BMJ – in press.)
6 Vally H, Taylor ML, Thompson PJ. The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Thorax 2002;57:569-574.
7 Stevenson DD, Hankammer MA, Mathison DA, Christiansen SC, Simon RA. Aspirin desensitization treatment of aspirin-sensitive patients with rhinosinusitis-asthma: long-term outcomes. J Allergy Clin Immunol. 1996 Oct;98(4):751-8.
8 Settipane RA, Schrank PJ, Simon RA, Mathison DA, Christiansen SC, Stevenson DD. Prevalence of cross sensitivity with acetaminophen in aspirin sensitive asthmatic subjects. J Allergy Clin Immunol 1995; 96:480-5.
9 Dahlen B, Szczeklik A, Murray JJ. Celecoxib in patients with asthma and aspirin intolerance. The Celecoxib in Aspirin-Intolerant Asthma Study Group. N Engl J Med. 2001 Jan 11;344(2):142.
10 Stevenson DD, Simon RA. Lack of cross-reactivity between rofecoxib and aspirin in aspirin-sensitive patients with asthma. J Allergy Clin Immunol. 2001 Jul;108(1):47-51.
11 Glasgow JFT and Middleton B. Reye syndrome – insights on causation and prognosis. Arch Dis Child 2001;85:351-353.
12 De Almeida MAM, Gaspar AP, Carvalho FS, Nogueira A, Pinto JER. Adverse reactions to acetominophen, ASA and NSAIDs in children: what alternatives? Allergy and Asthma Proc 1977;18:313-318.
13 Sansom L (Editor). Australian Pharmaceutical Formulary and Handbook 18th Edition. Pharmaceutical Society of Australia 2002; 164.
14 Kemp C, McDowell J (Chief Editors). Paediatric Pharmacopoeia, 13th Edition. Pharmacy Department, Royal Children’s Hospital Melbourne 2002.
15 Fischer TJ, Guilfoile TD, Kesarwala HH, Winant JG, Kearns GL, Gartside PS, Moornaw CJ. Adverse pulmonary responses to aspirin and acetominophen in chronic childhood asthma. Paediatrics 1983:71;313-318.
16 Lesko SM, Louik C, Vezina RM and Mitchell AA. Asthma morbidity after the short-term use of ibuprofen in children. Pediatrics 2002:109(2):1-4.
17 Rachelefsky GS, Coulson A, Siegel SC, Stiehm. Aspirin intolerance in chronic childhood asthma: detected by oral challenge. Pediatrics 1975;56:443-448.
18 Vedanthan PK, Menon MM, Bell TD, Bergin D. Aspirin and tartrazine oral challenge: incidence of adverse response in chronic childhood asthma. J Allergy Clin Immunol 1977;60:8-13.
19 Botey J, Navarro C, Marin A, Eseverri JL. Aspirin-induced asthma in children. Allergol et Immunopathol 1988;16(3):145-149.
20 Schuhl JF, Pereyra JG. Oral acetylsalicylic acid (aspirin) challenge in asthmatic children. Clinical Allergy 1979;9:83-88.
21 Towns SJ and Mellis CM. Role of acetyl salicylic acid and sodium metabisulfite in chronic childhood asthma. Pediatrics 1984;73(5):631-637.
22 ADRAC, case report, direct communication, August 2002.
23 Caswell A (Ed) (2002) E-MIMs May 2002 MediMedia Australia Pty Ltd NSW.
24 Levy S, Volans G. The use of analgesics in patients with asthma. Drug Safety 2001:24 (11) 829-841.

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