Justin R Chen1, Brett L Buchmiller1, David A Khan2. 1. Division of Allergy and Immunology, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, Tex. 2. Division of Allergy and Immunology, Department of Internal Medicine, the University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: dave.khan@utsouthwestern.edu.
Abstract
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. CONCLUSION: 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.
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 outpatientallergy 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. CONCLUSION: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.
Authors: Elina Jerschow; Matthew L Edin; Teresa Pelletier; Waleed M Abuzeid; Nadeem A Akbar; Marc Gibber; Marvin Fried; Fred B Lih; Artiom Gruzdev; J Alyce Bradbury; Weiguo Han; Golda Hudes; Taha Keskin; Victor L Schuster; Simon Spivack; Darryl C Zeldin; David Rosenstreich Journal: J Allergy Clin Immunol Pract Date: 2017-01-31
Authors: Elina Jerschow; Zhen Ren; Golda Hudes; Marek Sanak; Esperanza Morales; Victor Schuster; Simon D Spivack; David Rosenstreich Journal: Ann Allergy Asthma Immunol Date: 2016-01-25 Impact factor: 6.347
Authors: Whitney W Stevens; Elina Jerschow; Alan P Baptist; Larry Borish; John V Bosso; Kathleen M Buchheit; Katherine N Cahill; Paloma Campo; Seong H Cho; Anjeni Keswani; Joshua M Levy; Anil Nanda; Tanya M Laidlaw; Andrew A White Journal: J Allergy Clin Immunol Date: 2020-12-09 Impact factor: 10.793