Recurrent urticaria induced by aspirin in a post-stent patient: A case study and literature review

This report describes the case of a male in his early 60s with coronary heart disease who developed recurrent urticaria following the initiation of antiplatelet and lipid-lowering therapy. Through sequential drug dechallenge and rechallenge, aspirin was identified as the probable cause. Despite initial treatment with cetirizine and reintroduction of aspirin, the patient’s symptoms recurred, necessitating readmission. A multidisciplinary team, including clinicians and clinical pharmacists, optimized the treatment strategy by replacing aspirin with ticagrelor and cilostazol for antiplatelet therapy, discontinuing and reintroducing atorvastatin to rule out drug allergy, and administering desloratadine citrate and methylprednisolone for antiallergic treatment. The patient’s urticaria resolved completely without recurrence, and aspirin was identified as the probable cause using the adverse drug reaction causality assessment scale. Although aspirin was reintroduced on Day 2, the concurrent use of multiple drugs, including corticosteroids and antihistamines, may have influenced the timing and severity of the subsequent urticaria recurrence. Postdischarge follow-up confirmed sustained remission, highlighting the importance of collaborative care in managing drug-induced urticaria and maintaining cardiovascular safety.