SAN FRANCISCO – A small, retrospective study suggests that patients with aspirin-exacerbated respiratory disease may be safely desensitized to aspirin in an office setting rather than in a hospital.
Each of 15 patients who underwent a 1-day aspirin desensitization protocol in a clinic completed the protocol and ingested a cumulative total of 568 mg of aspirin on average by the end of the day. Each was then able to tolerate taking aspirin up to 650 mg b.i.d., Richard S. Dunn and Dr. Richard W. Hendershot reported in a poster presentation at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Mr. Richard S. Dunn
In-hospital aspirin desensitization for patients with aspirin-exacerbated respiratory disease typically takes 2-3 days, and some clinicians recommend doing it in an ICU, said Mr. Dunn, a fourth-year medical student at the University of Utah, Salt Lake City. Dr. Hendershot is an allergy and immunology specialist with Intermountain Healthcare in Salt Lake City.
The outpatient protocol took 8-9 hours. The cost to desensitize a patient averaged $2,678 in the outpatient clinic, compared with an average daily cost for ICU care of $13,347 reported in the literature.
Desensitization started with application of intranasal ketorolac three times over half-hour intervals. Patients then ingested 81 mg of aspirin and increased the dose by 81 mg every 2 hours to a final dose of 325 mg.
They were closely monitored during the desensitization. No complications were seen in 56% of patients. FEV1 (forced expiratory volume in 1 second) decreased by more than 20% in 19% of patients; 13% of patients developed flushing, and dyspnea or urticaria was each seen in 6% of patients.
Approximately 21% of people with asthma and 40% of patients with asthma who are dependent on glucocorticoids have aspirin-exacerbated respiratory disease. These patients often present with asthma, chronic rhinosinusitis, and nasal polyps. If they ingest a cyclooxygenase-1 inhibitor, they develop asthma symptoms, rhinorrhea, periorbital edema, urticaria, pruritus, angioedema, anaphylaxis, or other symptoms.
The design of the desensitization protocol was borrowed from a similar protocol that was tested in a controlled study of 100 patients (Ann. Allergy Asthma Immunol. 2010;105:130-5).
A patient who could not afford desensitization in the hospital inspired the development of the outpatient protocol that was used in the study.
The results suggest that aspirin desensitization for the treatment of aspirin-exacerbated respiratory disease can be done safely and efficaciously in the outpatient setting in less time and with less cost, compared with inpatient treatment protocols, the investigators concluded.
The investigators reported having no conflicts of interest.