Aspirin has been known for a long time and currently stays as a cornerstone of antithrombotic therapy in cardiovascular disease. In patients with either acute or chronic coronary syndromes undergoing percutaneous coronary intervention aspirin is mandatory in a dual antiplatelet therapy regimen for prevention of stent thrombosis and/or new ischaemic events. Aspirin is also currently a first-option antithrombotic therapy after an aortic prosthetic valve replacement and is occasionally required in addition to oral anticoagulants after implantation of a mechanical valve. Presumed or demonstrated aspirin hypersensitivity is a main clinical problem, limiting the use of a life-saving medication. In the general population, aspirin hypersensitivity has a prevalence of 0.6%–2.5% and has a plethora of clinical presentations, ranging from aspirin-exacerbated respiratory disease to anaphylaxis. Although infrequent, when encountered in clinical practice aspirin hypersensitivity poses for cardiologists a clinical dilemma, which should never be trivialized, avoiding—as much as possible—omission of the drug. We here review the epidemiology of aspirin hypersensitivity, provide an outline of pathophysiological mechanisms and clinical presentations, and review management options, starting from a characterization of true aspirin allergy—in contrast to intolerance—to suggestion of desensitization protocols.

中文翻译：

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阿司匹林过敏：心脏病专家实用指南

阿司匹林早已为人所知，目前仍然是心血管疾病抗血栓治疗的基石。对于接受经皮冠状动脉介入治疗的急性或慢性冠状动脉综合征患者，双联抗血小板治疗方案中必须使用阿司匹林，以预防支架内血栓形成和/或新的缺血事件。阿司匹林目前也是主动脉人工瓣膜置换术后的首选抗血栓治疗，并且在植入机械瓣膜后除了口服抗凝剂外偶尔还需要阿司匹林。推测或证实的阿司匹林过敏是一个主要的临床问题，限制了救生药物的使用。在一般人群中，阿司匹林过敏症的患病率为 0.6%–2.5%，并且有多种临床表现，从阿司匹林加剧的呼吸道疾病到过敏反应。虽然不常见，但在临床实践中遇到阿司匹林过敏症会给心脏病专家带来临床困境，决不应该轻视这一点，应尽可能避免遗漏该药物。我们在这里回顾阿司匹林过敏的流行病学，提供病理生理学机制和临床表现的概述，并回顾管理方案，从真正的阿司匹林过敏的特征（与不耐受相比）开始，到脱敏方案的建议。