Single-Day Oral Desensitization for Aspirin-Exacerbated Respiratory Disease

In patients with aspirin-exacerbated respiratory disease (AERD), use of a single-day oral aspirin desensitization procedure appears to be safe and effective, according to the results of review that will be presented at the American College of Allergy, Asthma & Immunology (ACAAI) 2022 Annual Scientific Meeting, held from November 10 to 14, 2022.

The management of AERD — a chronic disorder characterized by polyposis, asthma, and sensitivity to nonsteroidal anti-inflammatory drugs — historically required at least 2 days to manage. There are few studies that have evaluated specific phenotypes with the use of a 1-day oral aspirin desensitization protocol.

Researchers conducted a single-center, retrospective chart review and analyzed all patients (N=36) with AERD who underwent a rapid, 1-day aspirin desensitization procedure between October 2018 and April 2022. Data were assessed with the use of descriptive statistics.

Overall, 89% (n=32) of the participants underwent successful aspirin desensitization; 66% (n=21) of the successful desensitization procedures were completed in 1 day (6.4 hours) and 34% (n=11) of the procedures were completed in 2 days (9.4 hours).

The most common aspirin dose to elicit symptoms was 81 mg in the 1-day group and 120 mg in the 2-day group. In both groups, the most commonly-reported symptoms were sinonasal symptoms.

Overall, 38% (n=8) of the participants who underwent a 1-day procedure discontinued aspirin maintenance therapy, of which 50% (n=4) initiated treatment with dupilumab. In a similar fashion, 27% (n=3) of participants who underwent a 2-day desensitization procedure discontinued aspirin maintenance therapy, of which 33% (n=1) initiated dupilumab therapy.

Of the 4 participants who failed the desensitization procedure, 3 experienced severe gastrointestinal symptoms — most likely a reaction to aspirin — and 1 individual required epinephrine administration.

According to the authors, “Further research is necessary to explore the role of gastrointestinal reactions in AERD and the likelihood of failing aspirin desensitization.”