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April 6th, 2011
02:33 PM ET

Allergic to aspirin: Are there alternatives?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

Question asked by Mary of Fort Wayne, Indiana

I am allergic to aspirin and wonder: If I ever needed a blood thinner or daily aspirin, is there any option for me? There is a history of heart disease in my mother's family. I do take irbesartan (Avapro) for high blood pressure and simvastatin (Zocor) for cholesterol control.

Expert answer

Dear Mary:

Aspirin is an old drug with lots of uses. It was noted more than 2,000 years ago that chewing the bark of the willow tree was therapeutic for headache, some musculoskeletal pains and fever. The compound responsible for these effects was isolated more than a century ago, turned into a pill and named aspirin. Aspirin was the first of a class of drugs known as nonsteroidal anti-inflammatories, or NSAIDs. Today, NSAIDs are some of the most commonly used drugs in medicine.

After aspirin had been in use for more than 70 years, studies showed that it could reduce the risk of cardiovascular disease. We continue to learn about these compounds. We now know that most of the other NSAIDs do not reduce the risk of cardiovascular disease, and some actually increase it. More recently, studies also have shown that aspirin and several other NSAIDs may reduce the risk of colon polyps and colon cancer.

Your question is important, as it has been estimated that 5% of people have some difficulty taking aspirin or other NSAIDs. These reactions are categorized as pseudo-allergic or allergic. Pseudo-allergic reactions are nonimmunologic reactions related to the person having an alteration in the biochemical pathway through which the NSAID is normally metabolized or handled after it is ingested. True allergic reactions are due to the immune system rejecting the drug. Both reactions can be acquired, meaning someone can have no difficulty with NSAIDs for years and then all of a sudden have a reaction.

The person with a pseudo-allergic reaction tends to have the reaction with a number of NSAIDs, whereas those with true allergic reactions tend to be sensitive to one specific NSAID. Some patients also have a reaction to a high dose of an NSAID but not to a lower dose of the same drug.

The pseudo-allergic and true allergic reactions can be a combination of drug-induced asthma, runny and stuffy nose, itching or swelling. Some people have severe swelling of the throat and upper airway that can lead to suffocation in very severe reactions. Patients with a history of nasal polyps are at especially high risk of NSAID allergy.

The cardiovascular effects of aspirin are due to its ability to decrease the effectiveness of platelets in the blood. This decreases the blood's ability to clot. Today, aspirin is commonly prescribed to reduce the risk of vascular problems in patients who have had:

  • An acute myocardial infarction (or heart attack),
  • An occlusive stroke (a stroke caused by a blood clot),
  • A transient ischemic attack (also known as a TIA or mini-stroke),
  • Stable cardiac chest pain or angina
  • Heart bypass surgery.
  • Aspirin therapy decreases the risk of a subsequent cardiovascular event in this population by up to 20%. Several well-designed clinical trials have also established the net benefits of giving an aspirin to a person who is actively having a heart attack. It can decrease the amount of heart damage and cut the risk of death from the heart attack.

    There has been debate about the use of low-dose or baby aspirin (81 mg daily) or whole adult aspirin (325 mg daily) for disease prevention. The prevailing evidence is that there is no difference in efficacy or side effects in doses ranging from 81 mg to 325 mg per day.

    Some prescribe aspirin to people who have not had a cardiovascular event but are at high risk of cardiovascular disease because of diabetes, obesity, hypertension or smoking. The net benefit is clear among those with a history of cardiovascular disease but is less clear for this latter population. We use the term "net benefit" as it is clear that there are disadvantages to aspirin therapy. It causes some people to have stomach bleeding or even hemorrhagic stroke.

    Aspirin or NSAID desensitization is successful in some patients. This can allow for a daily prophylactic aspirin, or for patients with rheumatologic conditions to regularly take aspirin or other NSAIDs. This procedure involves starting with a low dose of the NSAID and progressively giving larger doses over time. It should be done under the supervision of a physician experienced in this procedure.

    Patients who need cardiovascular prevention who cannot be desensitized to aspirin may be candidates for therapy with the non-NSAID clopidogrel (Plavix). It, too, inhibits platelet activity and is sometimes used with aspirin.

    Acetaminophen (Tylenol) is not an NSAID. It is usually well tolerated by those with a history of NSAID reactions. Acetaminophen can be used for fever control and treatments of some types of pain. It is not useful in the prevention of cardiovascular disease.


    soundoff (36 Responses)
    1. bob

      Alternative to aspirin: red wine or beer. Think European!

      April 6, 2011 at 15:56 | Report abuse | Reply
      • Gibbs

        Good Choice.

        April 6, 2011 at 16:06 | Report abuse |
      • 12-21-12

        I wash my aspirin down with a beer!

        April 6, 2011 at 21:37 | Report abuse |
    2. Tapati

      Ginger has blood thinning properties. So does feverfew. These are milder and probably better for daily use than plavix which is used for more serious cases such as after a stent or if someone is showing more serious clotting problems. Keep in mind that a fatty meal makes the blood "stickier" so if you can't take daily aspirin you might be especially careful with your diet. Red wine is also good in moderation.

      April 6, 2011 at 16:35 | Report abuse | Reply
    3. ernie

      I've been told that fish oil is also a blood thinner.
      When I have a headache, aspirin doesn't work for me, I have to take Advil. It's not good to take Advil and Aspirin, so I take Fish Oil every day. And hey, I'm still here :)

      April 6, 2011 at 16:39 | Report abuse | Reply
      • 12-21-12

        How about irradiated fish oil!

        April 6, 2011 at 21:39 | Report abuse |
      • Gene

        A big YES on fish oil, Omega 3 Fatty Acid. They do help thin the blood, people on coumadin are advised not to take fish oil. O3FA is also a very good anti inflammatory. Many believe that it is the inflammation in the arteries that attract the cholesterol.

        April 7, 2011 at 10:45 | Report abuse |
    4. sam

      just stop drinking all that alcohol.......walllaaaaaaaaaaaaaaaaaaaaaaaaaaa

      April 6, 2011 at 17:26 | Report abuse | Reply
    5. Betsy Cross

      Wow. That was a really long answer for such a simple question.

      April 6, 2011 at 17:37 | Report abuse | Reply
      • Molly

        Thanks – I thought it was just me. The answer didn't come until the last 2 paragraphs!

        April 6, 2011 at 23:01 | Report abuse |
    6. Deer Hunter

      You can do any of the above, but it's still going to kill you.

      April 6, 2011 at 19:19 | Report abuse | Reply
    7. Bill

      So the only alternative to aspirin is Plavix? I thought Coumidan was a blood thinner, Vitamin K, and cod liver oil. There are various herbs that are supposed to prevent clotting but most seem to be based on anecdotal information.

      In any case, this was an interesting article.

      April 6, 2011 at 19:31 | Report abuse | Reply
    8. Bill

      What a stupid thing to interfere with nature. Don't be a glutton, exercise, and you will never have heart disease. Aspirin does not only thin your blood, but it will prevent your body from building strong arteries. Hence the bleeding.
      Just imagine drinking acetone that will destroy the inner lining of your stomach, lungs, other inner organs, intestines and arteries.

      Don't be stupid. 50 years from now doctors will discover what a dangerous thing blood thinning is. Let nature do its job. It knows better than you or the doctors.

      April 6, 2011 at 22:18 | Report abuse | Reply
      • blj

        Bill – you are stupid to think if you just exercise and eat right, you will not have heart disease. My father who was not overweight, in very good physical shape, did not smoke or drink, had a heart attack at 59. (by the way still going strong at 81) Where do you think this came from? Have you ever heard of familial diseases. I think you should read up on that before you say anything else!!

        April 7, 2011 at 08:53 | Report abuse |
      • Bill

        Your father must have done something else, like having too much stress in his life, being an extreme type A personality. Believe me, altering the chemical balance in your body doesn't go unpunished.
        Look at the wild animals. Have you seen birds or chipmunks having heart attacks? They eat natural food and are not sedentary. You are being a victim of an unscrupulous pharmaceutical industry. If you watch TV, most commercials are about how to fix ailments you might or might not have. It is their interest to make you think you are sick.

        April 7, 2011 at 10:39 | Report abuse |
      • Bill

        Besides, if the possibility of stomach bleeding does not scare the hell out of you, you must be extremely stupid.

        April 7, 2011 at 10:59 | Report abuse |
      • Jim

        All you Naturopathic wing nuts do a disservice to your cause. People can get heart disease even if they exercise and eat healthy if they have genetic factors that contribute to it. You throw out unsubstantiated drivel and ignore any scientific study. You are all conspiracy theorists and paranoid. Maybe if proponents of Naturopathic remedies didn't sound so crazy, people would take you more seriously. Aspirin comes from the bark of a tree (Natural). Yes stomach bleeding is a possible side affect if you take too much or already have an ulcer but most people are smart enough to know the symptoms and stop taking aspirin. Use your brain.

        April 7, 2011 at 11:44 | Report abuse |
      • Bill

        @Jim, who said anything about Naturopathic remedies? I said nature takes care of you if you don't screw yourself up. No need to fix what ain't broken. Just open up your eyes and see for yourself that the more you tinker with nature the more f.d up you get.

        April 7, 2011 at 20:08 | Report abuse |
    9. David

      The question was not answered because it wasn't really a question. I t was a teaser.

      April 7, 2011 at 01:04 | Report abuse | Reply
    10. CJS

      As someone who is extremely allergic to aspirin (hives and swelling of throat) – I don't feel the author answered the question as to alternatives to be used to prevent heart attacks. I even have reactions with the low dose baby aspirin. Tylenol for pain is an alternative but I am afraid to even use that. So are there any pill alternatives to aspirin for preventing heart attacks and stroke?

      April 7, 2011 at 06:18 | Report abuse | Reply
    11. Ralph Sayers

      You did not answer the person's question. You give a good run down of what aspirin is and can be used for, but they asked what alternative compunds they could use..???

      April 7, 2011 at 07:44 | Report abuse | Reply
    12. JM

      Here is the short version of this article:

      Question:
      ---–
      Got an allergy to Aspirin or the like?

      Answers:
      ---–
      1) Aspirin or NSAID desensitization (which I think was supposed to be the exiting part of this article)
      - OR –
      2) Plavix or the etc...(which is still good news, but not really anything that most people dont know already.)

      I know that they need to provide background information here for those readers who may not be familiar with the concepts involved, but.... jez – get to the point already! Whle you are at it, why don't you please clearly state your answer instead of breezing through it in the last two paragraphs. Otherwise I thought it was helpful.

      April 7, 2011 at 08:12 | Report abuse | Reply
    13. Boog

      Great primer on ASA. Unfortunately, the question was about *alternatives* to ASA. Fail.

      April 7, 2011 at 10:29 | Report abuse | Reply
    14. Dan

      Time-released Niacin as in SloNiacin doesn't thin the blood, but it does raise your HDL. If you can't take aspirin, this might give you some added protection. Too much time-release Niacin can cause liver problems, but you have to take quite a lot for that to happen. Surely, for example, 250 mg / day isn't going to hurt anything and it might help some.

      April 7, 2011 at 11:36 | Report abuse | Reply
    15. Jim

      Que the crazy Naturalists. Drugs are bad Nature good! If nature is so good go eat some mistletoe.

      April 7, 2011 at 11:47 | Report abuse | Reply
    16. jake

      All you have to do is consume marijuana it's just that simple.

      April 7, 2011 at 21:40 | Report abuse | Reply
    17. anna

      i suffered a severe allergic reaction to aspirin 10 years ago and luckily am here to tell about it. i know have to read labels on medication thoroughly, and it's unclear about what i can or can't take; "just tylenol" the doctor says. but with all the liver damage warnings, really?
      it is nice to know that there are alternatives (none of which are in the article. thank you readers for your advice!) but what is with the argument natural vs. manmade drugs? if it helps prevent and treat an ailment, who cares? JUST BE CAUTIOUS! everyone that takes herbs needs to know that they can be even more lethal than the man-made concoctions doctors shove down our throats. read labels do your research and be open-minded.

      April 8, 2011 at 15:09 | Report abuse | Reply
    18. Dr.Trish

      I get anaphylaxis (throat swelling and eyes swelling) to asprin and ibuprofen. I took Naproxen one time and did get wheezing. I don't believe this was a "pseudo" reaction and would caution your advise to people. Natural anti-inflammatory is boswelia also know as frankensense. I use this and have other patients use this without problem.
      To answer the question on alternate blood thinners, I agree with the above of fish oils and ginger.

      March 2, 2012 at 19:55 | Report abuse | Reply
    19. Mona Lisa

      What about Krill Oil? Does that thin the blood?

      January 21, 2013 at 03:16 | Report abuse | Reply
    20. Frederick Beaudreault

      Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying polyps before they become colon cancer. ,

      Newest write-up on our web page
      <.http://www.healthmedicinelab.com/is-bronchitis-contagious/

      February 28, 2013 at 05:35 | Report abuse | Reply
    21. deena

      I read an article years ago about Pycnogenol as an aspirin alternative. Anyone hear about that?

      March 9, 2013 at 09:06 | Report abuse | Reply
    22. Noble Man

      Aspirin is killing dose. I have taken for 2 months. It was like it is killing me. Thank God I found an alternate. Eat two tomatoes daily till you found new medicine FruitFlow in market or Sirco juice (available in UK so for). More details http://asimduttaroy.com

      June 13, 2013 at 18:57 | Report abuse | Reply
    23. Ellen M Brown

      I think my patient DIED before we got to the ANSWER IN THE LAST 2 PARAGRAPHS !!!

      November 12, 2013 at 08:56 | Report abuse | Reply
    24. GRAHAM BELL

      Hi I take asprin daily after a heart attack and quadruple by pass, It is 75mg. Is there an alternative natural remedy I could take because if I cut myself I bleed like a ..... you know what?

      Graham Bell thanks

      November 14, 2013 at 04:21 | Report abuse | Reply
    25. jerry

      what happened to the answer for what about krill oil so no one read this question? geeees

      January 7, 2014 at 20:17 | Report abuse | Reply
    26. Ronnie

      According to this article Krill Oil does work as a natural blood thinker:

      http://www.gnet.org/krill-oil/

      April 9, 2014 at 14:04 | Report abuse | Reply

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