A clinical study of cardiac patients who suffered an allergic reaction to the widely-prescribed drug Clopidogrel ( Plavix ), found that treatment with a combination of steroids and antihistamines can alleviate the allergic reaction symptoms thereby allowing patients to remain on the drug.

The study followed 24 patients, who developed Clopidogrel after undergoing coronary stent procedures. Eighty-eight percent ( 21 of 24 ) were able to stay on Clopidogrel uninterrupted after being treated with the antihistamines and a short course of steroids.

" This is a very important study for many cardiac patients but especially those with stents," said Michael P. Savage at Thomas Jefferson University Hospital. " Every patient who receives a stent must take Clopidogrel to help prevent stent thrombosis which is clotting of the stent. This obviously poses major problems if the patient suffers an allergic reaction to the medication. To discontinue taking the drug can lead to a heart attack which may be fatal. Those with a drug eluting stent are required to be on the drug for at least one year. Our patients with drug eluting stents actually averaged 17 months on Clopidogrel versus the minimum of one year. That's a very long time to not be on a medication that may save your life."

John R. Cohn, at Thomas Jefferson University and Hospitals and a key contributor to the study noted, " Previously, when patients had an allergic reaction to Clopidogrel we would give an alternative drug but they can have their own side effects. Rather than giving the secondary drug we concentrated on suppressing the patient's allergic symptoms they were having to Clopidogrel by administering low doses of steroids and antihistamines while continuing the drug. What we found was that most of our patients became tolerant to Clopidogrel, essentially becoming desensitized to the drug enabling them to continue treatment. Once this occurred we were able to discontinue the steroids and even the antihistamines."

Previous anecdotal studies showed some evidence that patients could be desensitized to Clopidogrel, but this is the first systematic study to demonstrate allergy to the drug could be managed without stopping the drug after a reaction was found.

“ Clopidogrel is a necessity in treating many cardiac patients, especially those with stents. Patients with allergic reactions have few alternatives and stopping Plavix can result in life-threatening complications. We needed to find a way to keep Clopidogrel-allergic cardiac patients on this drug to help ensure positive cardiovascular outcomes and in this small group we did. Hopefully, in the future, we can expand the study and investigate ways to apply this in treating allergic reactions to other life-saving drugs, " said Campbell.

Source: Thomas Jefferson University, 2009

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