title: A retrospective study of the clinical benefit from acetylsalicylic acid desensitization in patients with nasal polyposis and asthma.
abstract: BACKGROUND
  Aspirin-exacerbated respiratory disease (AERD), also known as Samter's triad, is a clinical syndrome which consists of aspirin (ASA) intolerance, chronic rhinosinusitis with nasal polyposis, and intrinsic bronchial asthma (Press Med 119:48-51, 1922). ASA challenge is the gold standard for diagnosing AERD (Curr Allergy Asthma 9:155-163, 2009). The practice of ASA challenge and desensitization in Canada is infrequently utilized, which may explain its omission as a viable therapeutic option in the latest Canadian clinical practice guidelines for acute and chronic rhinosinusitis (AACI 7:1-38, 2011).
  
  
  METHODS
  This retrospective study assessed 111 patients who underwent ASA desensitization in the Allergy and Immunology clinic at St. Joseph's Healthcare (SJHC) in London, Ontario. The mean age was 50.7 years, and 52.5% (n = 58) were male. Sixty-one percent (n = 68) claimed prior, significant reactions to ASA, and all patients had features of AERD.
  
  
  RESULTS
  Seventy-three percent (n = 81) claimed symptom improvement after achieving maintenance dosing on the desensitization protocol. Of this population, 21.6% (n = 24) improved in all 3 areas of interest (sense of taste or smell, upper respiratory symptoms and lower respiratory symptoms). Twenty-six percent (n = 29) had adverse effects, mostly in the way of gastrointestinal upset, but no severe adverse events were seen.
  
  
  CONCLUSIONS
  ASA desensitization helps improve symptoms in patients with AERD. Further, it allows patients to tolerate additional ASA and other non-steroidal anti-inflammatories (NSAIDs) when needed for supplemental analgesia or for cardio-protection. This is of particular benefit in those who require these medications for improved quality of life, and for reduced morbidity and mortality, such as those with cardiovascular disease or chronic pain. There should be further studies conducted in Canada as well as consideration for ASA desensitization to be included in the next clinical practice guidelines.
authors.affiliation: Schulich School of Medicine and Dentistry, London, Ontario Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Ibrahim
authors.affiliation: Schulich School of Medicine and Dentistry, London, Ontario Canada.
authors.forename: Kulraj
authors.initials: K
authors.lastname: Singh
authors.affiliation: Schulich School of Medicine and Dentistry, London, Ontario Canada ; Department of Allergy and Immunology, London, Ontario Canada.
authors.forename: Gina
authors.initials: G
authors.lastname: Tsai
authors.affiliation: Schulich School of Medicine and Dentistry, London, Ontario Canada ; Department of Allergy and Immunology, London, Ontario Canada.
authors.forename: David
authors.initials: D
authors.lastname: Huang
authors.affiliation: Schulich School of Medicine and Dentistry, London, Ontario Canada ; Department of Allergy and Immunology, London, Ontario Canada.
authors.forename: Jorge
authors.initials: J
authors.lastname: Mazza
authors.affiliation: Schulich School of Medicine and Dentistry, London, Ontario Canada ; Department of Otolaryngology, London, Ontario Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Rotenberg
authors.affiliation: Schulich School of Medicine and Dentistry, London, Ontario Canada ; Department of Allergy and Immunology, London, Ontario Canada.
authors.forename: Harold
authors.initials: H
authors.lastname: Kim
authors.affiliation: Schulich School of Medicine and Dentistry, London, Ontario Canada ; Department of Allergy and Immunology, London, Ontario Canada.
authors.forename: David William
authors.initials: DW
authors.lastname: Moote
keywords: Aspirin desensitization; Aspirin-exacerbated respiratory disease; Asthma; Nasal polyposis; Rhinosinusitis