A one-day, 90-minute aspirin challenge and desensitization protocol in aspirin-exacerbated respiratory disease

Publication date: Available online 2 November 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Geneva A. DeGregorio, Joseph Singer, Katherine N. Cahill, Tanya Laidlaw

ABSTRACT

Background

Aspirin challenge and desensitization remains the gold 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 one day.

Methods

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

Results

Ninety-three percent of patients completed the challenge and desensitization in one day, with an average protocol completion time of 9 hours and 29 minutes. Two patients (4.6%) chose to complete the protocol over two days. One patient (2.3%) was discontinued from the protocol due to on-going 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 >70% can be safely desensitized to aspirin using a 90-minute dose escalation protocol, starting at a dose of 40.5mg, and defining desensitization as tolerance of the repeated provocation dose and at least one subsequent aspirin dose, bringing total cumulative daily dose to ≥325mg. This protocol can routinely be completed in one day.

Updating the current aspirin challenge and desensitization guidelines to include these three key elements will allow for maintaining an exceptional safety profile while increasing efficiency of this procedure.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PF57aJ