title: Rational approach to aspirin dosing during oral challenges and desensitization of patients with aspirin-exacerbated respiratory disease.
abstract: 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.
authors.affiliation: Allergy Department, Kaiser Permanente Santa Clara, Santa Clara, Calif, USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Hope
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Woessner
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Simon
authors.forename: Donald D
authors.initials: DD
authors.lastname: Stevenson
mesh_terms: 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
chemical_list: D001241:Aspirin