Rational approach to aspirin dosing during oral challenges and desensitization of patients with aspirin-exacerbated respiratory disease

• Published in: Journal of allergy and clinical immunology Vol. 123; no. 2; pp. 406 - 410
• Main Authors: Hope, Andrew P., MD, Woessner, Katharine A., MD, Simon, Ronald A., MD, Stevenson, Donald D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2009; Elsevier; Elsevier Limited
• Subjects: Administration, Oral; Adult; Allergy and Immunology; Aspirin; Aspirin - administration & dosage; Aspirin - adverse effects; Aspirin - immunology; aspirin-exacerbated respiratory disease; asthma; Asthma - chemically induced; Asthma - immunology; Asthma - physiopathology; Asthma - therapy; Biological and medical sciences; Bronchi - drug effects; Bronchi - physiopathology; Bronchial Provocation Tests; Desensitization, Immunologic - methods; drug allergy; drug desensitization; Drug dosages; Drug Hypersensitivity - complications; Drug Hypersensitivity - immunology; Drug Hypersensitivity - physiopathology; Drug therapy; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Medical sciences; Middle Aged; oral challenge; polyps; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; sinusitis; Studies; Aspirin; polyps; Leukotriene-modifying drug; OR; drug allergy; oral challenge; drug desensitization; NSAID; aspirin-exacerbated respiratory disease; AERD; asthma; Acetylsalicylic acid; ASA; Emergency department; Nonsteroidal anti-inflammatory drug; sinusitis; Odds ratio; LTMD; ED; Prostaglandin-endoperoxide synthase; Allergy; Posology; Sinusitis; Immunology; ENT disease; Bronchus disease; Obstructive pulmonary disease; Salicylates; Polyp; Human; Drug; Lung disease; Immunopathology; Desensitization; Enzyme; Respiratory disease; Enzyme inhibitor; Antiplatelet agent; Asthma; Paranasal sinus disease; Oxidoreductases; Provocation test
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2008.09.048

Background Aspirin desensitization improves clinical outcomes in most patients with aspirin-exacerbated respiratory disease. Most protocols for desensitization are time-consuming. Objective Our objective was to use historical information about the course of aspirin desensitization to enhance the efficiency of the desensitization protocol. Methods Four hundred twenty subjects with suspected aspirin-exacerbated respiratory disease underwent oral aspirin challenges. Their clinical characteristics were analyzed in relation to features of reactions during aspirin challenges. Results Large (FEV1 decrease >30%) and moderate (FEV1 decrease 21% to 30%) bronchial reactions occurred in 9% and 20% of subjects, respectively. Multivariate analysis identified risk factors associated with these larger reactions, including lack of leukotriene modifier use, baseline FEV1 of less than 80% of predicted value, and previous asthma-related emergency department visits. Seventy-five percent of patients reacted to a provoking dose of either 45 or 60 mg. Only 3% of initial reactions occurred after 150- or 325-mg provoking doses, and none occurred after the 650-mg dose. Conclusions Most bronchial and naso-ocular reactions during oral aspirin challenges occurred within a narrow dosing range (45-100 mg). Only 1 of 26 patients without risk factors had a moderate reaction.