The patient reported that her symptoms continued despite increased therapy. The patientвЂ™s symptoms persisted despite an increase in medication dosage as well as the addition of hydrocortisone enemas to her therapy, therefore infliximab 5mg/kg per infusion was initiated. 2 After 3 months of therapy, the patient reported worsening of abdominal symptoms, therefore her azathioprine dose was increased. Past Treatment Regimen: Although oral and rectal mesalamine was indicated initially, treatment with azathioprine and prednisone was chosen given the patientвЂ™s allergy history. Assessment of the patient eliminated the possibility of infectious causes. Additionally, the patient more recently experienced diffuse pruritus and edema upon administration of ibuprofen and naproxen. Upon ingestion of aspirin as a child, she reported occurrence of urticaria and laryngeal angioedema requiring intubation. 2 Her active, moderate colitis involved the entire colon and she stated that she experienced predominant rectal symptoms. Presenting Complaint: A 33-year old woman with a history of drug hypersensitivity to NSAIDs and aspirin presented for management of her chronic UC with mesalamine. In a recent article published by Heath et al, a successful desensitization protocol was described in a patient that required mesalamine therapy who had a history of hypersensitivity to aspirin and nonsteroidal anti-inflammatory (NSAID) drugs. 2 Some research suggests that cross-reactivity between aspirin and mesalamine does not occur, while other reports state that a test dose should be administered in patients with a history of aspirin hypersensitivity prior to initiation of mesalamine. Not only is the literature regarding the cross-reactivity between aspirin and mesalamine lacking, but published evidence about the relationship is also conflicting. Because significant systemic absorption occurs with mesalamine, drug allergies are important to consider when treating a patient. 2 Mesalamine, which is structurally similar to aspirin, decreases inflammation via inhibition of cyclooxygenase (COX) 1 and 2 enzymes. 1 Pharmacologic therapy of mild to moderate UC typically begins with orally or rectally administered mesalamine.

Treatment of UC involves diet modification, initiation of medications, and surgical intervention, if necessary. 1 Diagnosis of UC requires both clinical evaluation as well as confirmation of the disease via colonoscopy and biopsy. 2 Patients may also experience weight loss and feelings of fatigue. 1,2 Symptoms of UC often include abdominal pain and discomfort, rectal urgency, diarrhea containing blood, and tenesmus. 1 In patients with UC, ulceration and inflammation of the colon leads to episodes of relapsing and remitting flares, making lifelong maintenance therapy necessary. Ulcerative colitis (UC) is a chronic condition that affects greater than 900,000 Americans and is also prevalent worldwide.

Nsaid cross reactivity chart