The clinical dilemma of "silent desensitization" in aspirin-exacerbated respiratory disease

• Published in: Allergy and asthma proceedings Vol. 34; no. 4; p. 378
• Main Authors: White, Andrew A, Bosso, John V, Stevenson, Donald D
• Format: Journal Article
• Language: English
• Published: United States 01.07.2013
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Aspirin - adverse effects; Aspirin - therapeutic use; Child; Desensitization, Immunologic - methods; Drug Hypersensitivity - drug therapy; Female; Humans; Male; Middle Aged; Respiratory Tract Diseases - chemically induced; Respiratory Tract Diseases - drug therapy; Young Adult
• ISSN: 1539-6304
• DOI: 10.2500/aap.2013.34.3670

Aspirin desensitization is a treatment option for patients with aspirin-exacerbated respiratory disease (AERD). Some patients with an excellent history of aspirin or nonsteroidal anti-inflammatory drug (NSAID) reactions have negative aspirin challenges/desensitization. This study discusses the clinical entity of silent desensitization in AERD and the dilemma that this presents to the practicing allergist/immunologist. We discuss a series of patients with a strong history of NSAID reactions who initially underwent a negative challenge/silent desensitization. These patients were subsequently proven to have AERD after a second positive aspirin challenge. Silent desensitization is an uncommon but important outcome to recognize in AERD. Clinicians performing aspirin desensitization should understand that this can occur and consider a second confirmatory aspirin challenge in some patients.