Saving time for AERD patients during aspirin challenge and desensitization
Published online: November 1, 2018
Patients with aspirin-exacerbated respiratory disease (AERD) have asthma, chronic nasal polyps and reactions to aspirin and other anti-inflammatory drugs (NSAIDs) that cause symptoms ranging from runny nose to life-threatening asthma attacks. AERD can be diagnosed by performing an aspirin challenge procedure, during which a patient ingests increasing doses of aspirin while being monitored closely to observe for a reaction. If the diagnosis is confirmed, a patient can then undergo desensitization to aspirin, getting increasingly larger doses over time until they are able to tolerate the medication as a daily therapy. Daily aspirin therapy can improve their asthma and nasal polyps and also allow them to take aspirin and NSAIDs if needed. Unfortunately, these procedures can be very burdensome for patients as the typical length of challenge and desensitization is three consecutive days with in office observation.
A recent study published by DeGregorio et al, in the The Journal of Allergy and Clinical Immunology: In Practice, aimed to establish that it can be possible to decrease the length of time it takes for patients to complete aspirin challenge and desensitization while maintaining safety. They examined data from 44 patients with AERD and stable asthma with FEV1 greater than or equal to 70% of predicted. Patients were given a starting oral dose of 40.5mg of aspirin and doses were then escalated over time using 90-minute intervals and fewer doses to reach the maximum goal of greater than or equal to 325mg aspirin ingested over the course of one day. When needed, reaction symptoms were treated with rescue medications to help the symptoms improve. Results were then compared to those of previous studies with longer protocols.
Ninety-three percent of patients completed the challenge and desensitization in one day, with an average protocol completion time of 9 hours and 29 minutes. Two patients (4.6%) chose to complete the protocol over two days. One patient (2.3%) was discontinued from the protocol due to on-going abdominal discomfort and diarrhea. No patient required epinephrine, emergency department visit or hospitalization. The protocol was faster and as safe as previously published longer protocols.
Patients with AERD on a stable asthma regimen and with a baseline FEV1 >70% can be safely desensitized to aspirin using a protocol that can be routinely completed in one day.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.