Expediting desensitization for aspirin-exacerbated respiratory disease

Published Online: August 14, 2015

Aspirin-exacerbated respiratory disease (AERD) is characterized by underlying asthma, chronic rhinosinusitis, and persistent sinonasal polyposis and is one of the most dangerous adverse reactions to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin desensitization therapy effectively reduces upper and lower respiratory symptoms in AERD. However, most established approaches require up to 3 days to complete, which represents a substantial time and financial commitment from patients and providers alike and is a potential barrier to its use.

A new study by Chen et al. published recently in The Journal of Allergy and Clinical Immunology: In Practice, retrospectively evaluates a protocol with the goal of achieving desensitization in 1-2 days and is applicable to the vast majority of patients with AERD. A cohort of patients with chronic rhinosinusitis, asthma, and nasal polyps reporting symptoms within one hour of aspirin or NSAID exposure were desensitized with a new protocol utilizing hourly intervals between escalating doses of aspirin which are fractions of commercially available aspirin tablets. In comparison, older protocols mandate three hours between doses. A total of 57 aspirin desensitizations were performed on patients qualifying for the hourly protocol, which encompassed over 86% of patients treated for AERD at the investigating institution over a thirteen-year period.  Ninety eight percent of patients successfully completed the accelerated protocol and were started on outpatient maintenance therapy with aspirin. All reactions were treated solely with medications available in the ambulatory setting, even in patients with a history of intubation. Patients finished in two days or less, with 40% doing so in a single day.  

This study describes a method of aspirin desensitization that substantially reduces the length of clinical exposure, can be safely done in the outpatient setting, and is simple to administer. This protocol has the potential to benefit practicing allergists, much of the AERD population, and third-party payors.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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