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Aspirin desensitization as a potential treatment for food-associated salicylate reactions

Question:

8/24/2018
Is it reasonable to do an aspirin desensitization for a patient with sampters triad that complains of reactions to foods with even small amounts of salycilate? He has nasal polyps (but they are not life changing) and his asthma is controlled.

Answer:

I performed a PubMed search and information related to your question was scarce at best. I consulted Dr. Tanya Laidlaw, who has authored articles on the topic of AERD, and asked her to provide a response. Here it is:

“Patients with AERD are generally able to tolerate foods that contain salicylates or salicylic acid in them, as their sensitivity to aspirin (which is acetylsalicylic acid) actually requires the acetyl group on the aspirin. It is the acetyl group from the aspirin that transfers onto the cyclooxygenase enzyme to inhibit it, and it is the inhibition of the cyclooxygenase enzyme that induces the classic aspirin-induced reactions in patients with AERD. Salicylic acid on its own is considered to be a very weak inhibitor of the cyclooxygenase enzymes, so it would be very unusual for it to be able to exert enough inhibition to cause clinically-notable reactions. There is no evidence to suggest that aspirin desensitization or initiation of daily aspirin therapy would prevent any reported salicylate-induced reactions.”

I hope this information is helpful to you.

Sincerely,
Jacqueline Pongracic, MD, FAAAAI