Patients are asked to not use antihistamines for 72 hours before the procedure so that their naso-ocular responses can be observed. Patients with nasal polyps may require debulking surgery prior to desensitization.
"We had recommended in the past that intravenous access be available, but we have data now that it may not be necessary," Dr. Woessner said.
On day 1 of sensitization, patients take 20-40 mg of aspirin at 8 a.m., 40-60 mg at 11 a.m., and 60-100 mg at 2 p.m. On day 2, the respective doses at the same times of day are 100-160 mg, 160-325 mg, and 325 mg.
During desensitization, FEV1 should be measured every hour, and should be at least 1.5 L and greater than 60% of predicted. When a patient has a reaction and that reaction is resolved, the provoking dose should be repeated, and if there is no reaction, the escalating doses can be continued every 3 hours as scheduled. Patients are considered to be densensitized or aspirin tolerant if they can take a 325-mg dose with no reaction. The patient should be instructed to start on 650-mg aspirin that night as the first daily dose, and to continue with up to 650 mg twice daily. About half of all patients can decrease to 325 mg b.i.d. at 1-6 months after the densensitization protocol is completed.
Combining a nasal ketorolac challenge with the oral aspirin challenge can make the desensitization even safer, Dr. Woessner said. The patient is given ketorolac spray at increasing doses every half-hour over 2 hours, followed 1 hour after the last spray with 60-mg aspirin in two doses 1.5 hours apart. The patient is discharged and returns the next day to receive 150-mg aspirin, followed 3 hours later by 325 mg.
No funding source was reported. Dr. Woessner disclosed that she is on the speakers bureaus of Merck and Teva, and has been a speaker for GlaxoSmithKline.