688
Unsuccessful Aspirin Desensitization in Minority Patients with AERD: Association with Increased Eosinophilia and Sinus Surgery Timing.
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Elina Jerschow, M.D., M.Sc., Teresa Pelletier, B.A., Ren Zhen, Robert Tamayev, M.D., Ph.D., Waleed Abuzeid, M.D., Marvin Fried, M.D., Golda Hudes, M.D. PhD, Esperanza Morales, Krista Nelson, B.F.A., Jonathan Feldman, PhD, Victor Schuster, M.D., Simon Spivack, M.D., M.P.H., David L. Rosenstreich, MD FAAAAI
Rationale:

Aspirin desensitization is an effective long-term treatment for aspirin-exacerbated respiratory disease (AERD) but this has been insufficiently studied in minority populations.

Methods:

Outcomes of aspirin desensitization (650 mg twice daily) in AERD patients were assessed at four weeks by determining changes in the Asthma Control Test (ACT) and forced expiratory volume in one second (FEV1). 

Results:

Of 34 patients recruited, 29 self-identified as ethnic minorities (19 African-Americans, 10 Hispanics). Eleven were successfully desensitized (all 5 Caucasians and 6 minorities). Twenty-three patients either had no change in symptoms (2 African-Americans, 4 Hispanics) or had worsening of symptoms (14 African-Americans, 3 Hispanics) (p<0.01). Of the 17 patients who worsened on aspirin, 5 had persistent GI and respiratory symptoms and declined further desensitization. Twelve continued aspirin for up to 4 weeks. Their FEV1 decreased from 80% predicted (IQR 71-93) to 69% (IQR 46-88) (p=0.002), and ACT scores decreased from 17 (IQR 14-22) to 10 (IQR 6-14.5) (p=0.003). These changes were accompanied by increased peripheral eosinophilia from 0.6 μk/L (IQR 0.4-0.8) to 1.0 μk/L (IQR 0.7-1.6), p=0.01. In the desensitization failure group, there was a significant correlation between FEV1% decrease and increase in eosinophilia after desensitization (r=-0.74, p=0.01).

All minority patients who failed aspirin desensitization either never had endoscopic sinus surgery (ESS) or had undergone ESS >6 months prior to desensitization (p=0.001). 

Conclusions:

Aspirin desensitization in this minority population was less successful than in Caucasians. Desensitization-induced eosinophilia was associated with poorer asthma control. No ESS and ESS>6months prior to desensitization was associated with unsuccessful treatment in minorities.