Rational approach to aspirin dosing during oral challenges and desensitization of patients with aspirin-exacerbated respiratory disease.
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 (FEV(1) decrease >30%) and moderate (FEV(1) 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 FEV(1) 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.
Hope
Andrew P
AP
Allergy Department, Kaiser Permanente Santa Clara, Santa Clara, Calif, USA.
Woessner
Katharine A
KA
Simon
Ronald A
RA
Stevenson
Donald D
DD
D000284:Administration, Oral; D000328:Adult; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D001249:Asthma / Q000139:chemically induced / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D001980:Bronchi / Q000187:drug effects / Q000503:physiopathology; D001985:Bronchial Provocation Tests; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000150:complications* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors
D001241:Aspirin