Reaction Doses in Aspirin Desensitization for Aspirin-Exacerbated Respiratory Disease
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Charles Schuler, MD, James L. Baldwin, MD FAAAAI, Alan P. Baptist, MD MPH FAAAAI
Rationale: Aspirin desensitization is a recommended procedure for patients with aspirin-exacerbated respiratory disease (AERD). Current protocols advise supervised aspirin administration up to doses of 325 mg with the 650 mg dose administered at home. It is unclear what percentage of patients reacts at 325 mg during desensitization.

Methods: A chart review of aspirin desensitization procedures for AERD performed from 2011-2015 at the University of Michigan Allergy/Immunology clinic was performed. Reactions and associated doses were characterized as upper or lower reactions, with severity marked by number of separate upper symptoms and FEV1 decrease. Baseline AERD history, prior aspirin challenge, medications, and spirometry were also collected.

Results: A total of 64 aspirin desensitization protocols were reviewed. 62% of subjects were on a leukotriene receptor antagonist and/or zileuton at desensitization. One patient reacted to 325 mg with a very mild lower respiratory symptom that resolved spontaneously without treatment. Twelve patients did not react, six of whom had a previous positive in-office aspirin challenge. All other patients had a reaction to a lower dose. The most frequent initial provoking dose was 81 mg. 64% of subjects had upper airway symptoms, 39% had lower symptoms, and 30% had both upper and lower symptoms. After an initial reaction at a lower provoking dose, no subject had a reaction when subsequently receiving the 325 mg dose.

Conclusions: During aspirin desensitization, there are extremely few reactions at the 325 mg dose. This suggests that the in-office portion of the desensitization protocol can be shortened.