Q. I've had a severe allergy to aspirin for years. Because of it, I've been somewhat limited in what medicines I can take for pain relief. Lately I have two new problems to deal with. After a heart attack, my cardiologist wanted me to take aspirin to help protect my heart. And my orthopedic surgeon wanted me to take some anti-inflammatory medicines after knee surgery. The surgeon told me, however, that all anti-inflammatory medicines are similar to aspirin and that I wouldn't be able to take any of them.

Is there a suitable substitute that I can take for either condition? I can't believe that there are no blood thinner medicines or anti-inflammatory drugs that won't react like aspirin.

A. You have a couple of choices. To help thin your blood and protect your heart, you can take a new, anti-platelet medicine called Plavix. Like aspirin, Plavix prevents clumping of platelets, the tiny particles that help your blood clot when you get a cut. In people with hardening of the arteries (atherosclerosis), platelets can clump together on plaques along the blood vessels. The clumping can ultimately block an artery and trigger a heart attack or stroke. Doctors use Plavix to prevent heart attacks or strokes in people who have hardening of the arteries.

A similar anti-platelet medicine is Ticlid. Doctors use it to help prevent strokes in people who have had a stroke or a transient ischemic attack, a momentary interruption of blood flow to the brain.

You're right that people who are allergic to aspirin can also be allergic to most other anti-inflammation pain relievers. Doctors refer to this phenomenon as a cross-reaction--an allergy to one substance making you allergic to a similar substance. Most anti-inflammation pain relievers belong to a group of medicines called NSAIDs (nonsteroidal anti-inflammatory drugs). Other nonprescription NSAIDs include ibuprofen (Motrin, Advil and other brands), Aleve and Orudis and more than a dozen prescription brands.

There are a few NSAIDs that have a low risk of cross-reacting with aspirin. Three nonaspirin, anti-inflammatory pain relievers are sodium salicylate, magnesium salicylate and choline salicylate (Arthropan). You can buy these without a prescription. Prescription NSAIDs that are not likely to trigger reactions in people with aspirin allergy are salsalate (Disalsid and other brands) and choline/magnesium salicylate combinations (Tricosal, Trilisate and other brands). Although these medicines, known as salicylates, are in the aspirin family, they differ enough from aspirin to have a low risk of cross-reacting. Still, if you have a severe allergy to aspirin, check first with your doctor to see if it's okay for you to take any of these.

If you need pain relief but don't really need an anti-inflammatory drug, you can take acetaminophen (Tylenol and other brands). Acetaminophen is not an NSAID, so it is safe to take if you have an aspirin allergy. And by an allergy to aspirin, I don't just mean that aspirin upsets your stomach, causes stomach bleeding or some other side effect. I mean that you have a true allergic reaction to aspirin, such as hives, skin rash, trouble breathing, wheezing or--in severe cases--shock.

I should also point out that people allergic to aspirin often have asthma, along with polyps inside their nose that can cause congestion. In addition, people with severe allergy to aspirin often are also allergic to tartrazine, a common dye that is used in foods and some medicines. If you have such an allergy, you'll need to read food labels carefully and ask your doctor or pharmacist to help you avoid it.

Jay Siwek, chairman of the department of family medicine at Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.

Consultation is a health education column and is not a substitute for medical advice from your physician. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, DC 20071. Questions cannot be answered personally.