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J Allergy Clin Immunol Pract. 2019 Apr;7(4):1174-1180. doi: 10.1016/j.jaip.2018.10.032. Epub 2018 Nov 2.

A 1-Day, 90-Minute Aspirin Challenge and Desensitization Protocol in Aspirin-Exacerbated Respiratory Disease.

Author information

1
Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
2
Department of Medicine, Harvard Medical School, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and the Jeff and Penny Vinik Center, Boston, Mass.
3
Divison of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tenn.
4
Department of Medicine, Harvard Medical School, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and the Jeff and Penny Vinik Center, Boston, Mass. Electronic address: tlaidlaw@bwh.harvard.edu.

Abstract

BACKGROUND:

Aspirin challenge and desensitization remains the criterion standard in diagnosis and treatment for patients with aspirin-exacerbated respiratory disease (AERD), but the protocols can be time and resource intensive.

OBJECTIVE:

To provide evidence that oral aspirin challenge and desensitization can be safely performed in an outpatient setting in 1 day.

METHODS:

Forty-four patients with a confirmed diagnosis of AERD, stable asthma, and baseline FEV1 value greater than or equal to 70% of predicted completed an oral aspirin challenge and desensitization protocol. The starting dose was 40.5 mg with escalating doses of aspirin (81, 162.5, 325 mg) at 90-minute intervals until symptoms were provoked. Desensitization was defined as tolerating a repeated administration of the provocative aspirin dose and at least 1 subsequent dose, bringing the total aspirin ingested during the in-clinic desensitization to 325 mg or more.

RESULTS:

Ninety-three percent of patients completed the challenge and desensitization in 1 day, with an average protocol completion time of 9 hours and 29 minutes. Two patients (4.6%) chose to complete the protocol over 2 days. One patient (2.3%) was discontinued from the protocol because of ongoing abdominal discomfort and diarrhea. No patient required epinephrine, emergency department visit, or hospitalization.

CONCLUSIONS:

Patients with AERD on a stable asthma regimen and with a baseline FEV1 value greater than or equal to 70% can be safely desensitized to aspirin using a 90-minute dose escalation protocol, starting at a dose of 40.5 mg, and defining desensitization as tolerance of the repeated provocation dose and at least 1 subsequent aspirin dose, bringing total cumulative daily dose to 325 mg or more. This protocol can routinely be completed in 1 day.

KEYWORDS:

AERD; Aspirin challenge; Aspirin desensitization; Aspirin-exacerbated respiratory disease

PMID:
30391549
PMCID:
PMC6456426
[Available on 2020-04-01]
DOI:
10.1016/j.jaip.2018.10.032

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