An Hourly Dose-Escalation Desensitization Protocol for Aspirin-Exacerbated Respiratory Disease.
BACKGROUND
Aspirin desensitization followed by maintenance therapy effectively improves symptom control in patients with aspirin exacerbated respiratory disease (AERD). The majority of current desensitization protocols use 3-hour dosing intervals and often require 2 to 3 days to complete.


OBJECTIVE
We evaluated hourly dose escalations in a subset of patients with chronic rhinosinusitis, nasal polyps, and asthma who historically reacted to aspirin within 1 hour or were avoiding aspirin with the goal of developing a safe and efficient desensitization protocol.


METHODS
Fifty-seven aspirin desensitizations were performed under the hourly protocol. All patients had refractory nasal polyposis as an indication for aspirin desensitization. The clinical characteristics of each subject were analyzed in relation to aspects of his or her reactions during the procedure.


RESULTS
Ninety-eight percent of study patients were successfully treated under the hourly protocol, including those with a history of severe reactions and intubation. None required further medication than is available in an outpatient allergy clinic. A total of 96% of reactors recorded a bronchial or naso-ocular reaction within 1 hour of the preceding dose. Of the total patients on this protocol, 40% were able to complete the procedure in a single day, and 60% within 2 days.


CONCLUSIONS
Patients with AERD who have a history of symptoms less than 1 hour after aspirin exposure can be safely desensitized with a 1-hour dose-escalation protocol that can often be completed in a single day.
Division of Allergy and Immunology, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, Tex.
Justin R
JR
Chen
Division of Allergy and Immunology, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, Tex.
Brett L
BL
Buchmiller
Division of Allergy and Immunology, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: dave.khan@utsouthwestern.edu.
David A
DA
Khan
D000284:Administration, Oral; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods*; D004306:Dose-Response Relationship, Immunologic; D004342:Drug Hypersensitivity / Q000276:immunology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012120:Respiration Disorders / Q000139:chemically induced* / Q000276:immunology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
Aspirin desensitization; Aspirin-exacerbated respiratory disease; Asthma; Chronic rhinosinusitis; Nasal polyps