An Alternative Aspirin Desensitization Protocol for Patients with Aspirin- Exacerbated Respiratory Disease

Background:Aspirin exacerbated respiratory disease (AERD) affects up to 5% to 15% of asthmatics. While aspirin desensitization is a safe treatment option and allows for aspirin to be used to control AERD symptoms, not all patients diagnosed with AERD are able to complete the standard desensitization protocol. Objective: For patients who cannot complete the standard desensitization protocol, we sought to create an alternative method that allows patients to reach a therapeutic maintenance dose of aspirin. Methods: We retrospectively analyzed patients that underwent AERD desensitization, identifying 5 patients that failed the standard desensitization protocol and 6 that elected to complete the alternative aspirin desensitization. Subjects started at a dose lower than their reaction dose and subsequently increased their dosage by 40.5 mg or 81 mg every 2 to 4 weeks, with the goal of reaching a dose of 325 mg BID. Results: Among the five patients that initially failed the standard desensitization protocol, our alternative desensitization protocol took an average of 6.1 months to reach a maintenance dose of 307 mg BID with an increase of 47.5 mg aspirin every two weeks. Of the six patients who elected to complete our alternative protocol, it took an average of 4.6 months to reach a maintenance dose of 244 mg BID with an increase of 38.7 mg every two weeks. Six patients successfully increased their aspirin dosage to 325 mg BID by following the alternative protocol. Conclusion: Based on the data, it seems possible that a graduated approach to the administration of aspirin could benefit a majority of those who fail or do not wish to complete the standard desensitization protocol.