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Month: February 2024

Allergy to Nonsteroidal Anti-Inflammatory Drugs (NSAID’s)

Nonsteroidal anti-inflammatory drugs (NSAID’s) are a group of medications related to aspirin.  The group includes commonly used drugs such as ibuprofen (i.e., Motrin, Advil), naproxen (i.e., Aleve, Naprosyn), diclofenac (i.e., Voltaren), etodolac, (i.e., Lodine), among others.  These agents are widely used in order to reduce inflammation (e.g., decrease pain and reduce swelling of joints in various forms of arthritis).  They also help reduce fever caused by infections as well as relieve discomfort after injuries.

NSAID’s act by blocking an enzyme called cyclooxygenase-1 (COX-1).  Cyclooxygenase-1 acts by producing compounds known as prostaglandins.  These prostaglandins are involved in tissue inflammation which results in pain, swelling, and/or fever.  Since NSAID’s block the enzyme cyclooxygenase-1, they also inhibit the production of prostaglandins.  Thus, NSAID’s will decrease tissue inflammation and reduce pain, swelling, and fever.  Aspirin not only blocks the enzyme cyclooxygenase-1, but it also blocks the cyclooxygenase-2 COX-2) enzyme as well.  Thus, aspirin also leads to a decrease in tissue inflammation as well as a reduction in pain, swelling, and fever.  In addition, aspirin decreases the activity of blood components known as platelets.  While platelets are known to promote the clotting of blood, aspirin, on the other hand, helps prevent blood clots due to its antagonistic effect on platelets, which reduces the risk of heart attacks and strokes.

Common side effects of aspirin may include bruising and abdominal pain.  Less commonly, a stomach ulcer or stomach bleeding may occur.  Very high doses of aspirin may cause confusion or ringing in the ears (i.e., tinnitus).

Aspirin can cause allergic reactions in some individuals.  These symptoms may include flushing, generalized itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema), nasal congestion, runny nose, and/or asthma usually within an hour of taking a tablet.  These reactions occur in approximately 1% of people receiving aspirin.  It should be pointed out that in patients with hives, nasal polyps and asthma, the risk could be as high as 30%.  The co-existence of asthma, nasal polyps, and aspirin sensitivity is termed Samter’s triad or aspirin exacerbated respiratory disease (AERD).

The manifestations of aspirin and NSAID sensitivity may include:

  • Itching, usually generalized
  • Hives
  • Swelling of soft tissues such as eyelids, lips, tongue, throat, etc.
  • Chest tightness, wheezing, coughing, shortness of breath
  • Dizziness and altered sensorium


The diagnosis of NSAID allergy is based mostly on the history of adverse effects within a short time after receiving the drug.  There is no reliable blood or skin allergy test for confirming or excluding the sensitivity to aspirin and NSAID’s.  The only way to assess aspirin sensitivity is by a graded open challenge under strict medical supervision.  Challenge testing is not always necessary, but may be advised in some circumstances in order to prove that sensitivity exists, or to prove the safety of an unrelated medication.


The treatment of NSAID allergy is directed at the relief of symptoms with antihistamines, bronchodilators, and epinephrine in cases of anaphylaxis.


Preventing NSAID reactions involves the total avoidance of aspirin and all cross- reacting NSAID’s.  As there are so many brand names of the same medication, and so many types of medications available, accidental exposure to aspirin or NSAID’s may occur.  NSAID’s are common ingredients of many over-the-counter painkillers and cold/flu remedies.

If you have ongoing hives, you should avoid aspirin and NSAID’s unless you know that you can tolerate them without a problem.  If you are already taking regular aspirin (for example, to prevent heart attack or stroke), or a regular arthritis tablet for the treatment of pain, then you should consult with your primary care physician, rheumatologist, or cardiologist about stopping the aspirin.  Your physician may tell you that you do not need to stop taking the aspirin unless your hives clearly get much worse after taking the medicine.  If you have had an allergic reaction to one type of NSAID, a challenge with a different drug can be considered if you need to take aspirin or an anti-inflammatory medication for the treatment of arthritis.

Some NSAID’s such as celecoxib (i.e., Celebrex) and meloxicam (i.e., Mobic) predominantly inhibit the cyclooxygenase-2 (COX-2) enzyme rather than the cyclooxygenase-1 (COX-1) enzyme.  Thus, they can be taken safely by many patients (but not all), who have aspirin and NSAID sensitivity.  Acetaminophen (i.e., Tylenol) and codeine do not usually cross-react with NSAID’s and can usually be taken safely for the relief of fever and/or pain.

Aspirin desensitization is a procedure that could be helpful in some patients with AERD to improve asthma control, inhibit nasal polyp growth, and to enable aspirin therapy for reducing the risk of blood clots in order to protect the heart and the brain.

The allergy specialists at Black & Kletz Allergy see both adult and pediatric patients and have over 5 decades of experience in the field of allergy, asthma, and immunology.  If you have or suspect you have a sensitivity or allergy to aspirin, NSAID, or any other medication, please call our office.  Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the greater Washington, DC metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy care in a welcoming and relaxed environment.

Allergies in the Spring Update

Well, it is almost Spring again. If you are one of those individuals with Spring allergies, you know that it is time for those miserable allergy symptoms to reappear unless you do something about it. The primary cause of Spring allergies is the tree pollen, although secondary allergens often include molds. The classic symptoms of Spring allergies may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, sinus headaches, fatigue, itchy eyes, watery eyes, and/or redness of the eyes. In addition, some individuals, especially those with asthma, may also develop or experience worsening of chest tightness, coughing, wheezing, and/or shortness of breath.

The pollination of trees in the Washington, DC, Northern Virginia, and Maryland metropolitan area usually begins in March and generally lasts until early May. It is interesting to note however that the pollination of trees throughout the country has been beginning earlier and earlier as time goes on, particularly in the last 20 years. Tree pollen is now found in the Washington, DC area in early February and occasionally in January when there are unusually warm days. As a result, sensitive individuals are finding themselves bothered by tree pollen much earlier in the year than in the past. Increasing levels of carbon dioxide are being documented every year causing many scientific researchers to believe that climate change is contributing to this trend.  Carbon dioxide is the primary gas needed for the growth and development of trees along with nutrients, water, and sunlight. Changes in the climate may impact the pollen seasons of trees, grasses, and weeds by both increasing the amount of pollen produced as well as by extending the duration of the pollen season.

Tree pollination is for all intents and purposes the reproductive season for the trees. Tree pollen grains are released into the atmosphere in order to fertilize the ovules of other trees.  Tree pollen is produced and dispersed by the wind throughout the day, but their counts are highest in the morning hours. Birch, oak, cedar, elm, ash, cottonwood, hickory, and maple are the predominant tree pollens in the Washington, DC metropolitan area.

A common fallacy is that if someone has a particular tree (i.e., oak) or many of those specific trees (i.e., oak) in their yard, they are more likely to have allergy problems from those trees if they are allergic to them. This in fact is not true since pollen is disbursed all over the region and it is not unheard of for the pollen to travel over 200 miles. For this reason, people can suffer from tree pollen allergy (i.e., oak) even if they live fairly far away from that nearest tree (i.e., oak).

Another misconception people have is that they are allergic to flowers that bloom in the Spring. These individuals assume that because they are experiencing allergy symptoms in the Spring when the flowers are blooming that they are allergic to the flowers. In reality, the flowers happen to be blooming the same time that the trees are pollinating and the allergy sufferers equate their worsening allergy symptoms with the flowers that they see. It is the tree pollen that is causing their hay fever (i.e., allergic rhinitis and allergic conjunctivitis) symptoms and not the flowers. As a matter of fact, another name for hay fever is “rose fever.” It is called rose fever because roses bloom in the Spring, at the same time tree pollen levels are high. It is interesting that the names hay fever and rose fever are also inaccurate in that there is no allergy to hay or roses and there is also no fever associated with the condition.

The diagnosis of Spring allergies begins with taking a comprehensive history and performing a complete physical examination.  Allergy testing by either skin testing or blood testing is performed in order to identify the offending allergen.  Once the allergen is identified, preventive measures are recommended in order to reduce the exposure to that allergen.

Some measures to diminish exposure to pollen which helps lessen symptoms may include the following:

  • Track the the local pollen counts on our homepage by clicking Today’s Pollen Count and avoid outside activities on days with high pollen counts.
  • Avoid activities in the early morning since the pollen counts are at their highest early in the mornings.
  • Plan to go outdoors after it rains as the pollen count is lower after a rain.
  • Shower before going to bed in order to wash the pollen off.
  • Close your windows in your house and automobiles, as well as run your air conditioning in order to help prevent pollen exposure.
  • Leave your shoes outside so you do not bring the pollen into the home.
  • Change one’s clothes and wash them after being outside.
  • Wash your pet before the animal comes inside.

The treatment of Spring allergies usually includes prevention of the offending allergen(s), therapy with medications, and/or allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization). There are a variety of medications that may be used in order to treat Spring allergies. Oral antihistamines, oral decongestants, oral leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular antihistamines, ocular mast cell stabilizers, inhaled bronchodilators, inhaled corticosteroids, and inhaled anticholinergics are some of the ammunitions used to prevent and treat allergy and asthma symptoms that may occur in the Spring and other times as well. Allergy immunotherapy, (more commonly referred to as allergy shots), are very effective. They work in approximately 80-85% of the patients who take allergy shots. They take about 4-6 months however to work and the average person is on them for about 3-5 years.

If you are suffering from a prolonged “cold” and/or are not sure if your symptoms may be due to allergies and you would like to be seen by one of our board certified allergists at one of Black & Kletz Allergy’s 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA, please call us to make an appointment. Alternatively, you can click Request an Appointment and we will get back to you within 24 hours by the next business day. We offer parking at each office location and we are Metro accessible at our Washington, DC and McLean, VA locations. We also offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Black & Kletz Allergy provides a welcoming and thoughtful environment for you to get the state-of-the-art allergy, asthma, and immunology treatment that we have been providing the community for more than 5 decades.