Predictive Factors of Reaction Severity during Standardized Aspirin Desensitization in Aspirin-Exacerbated Respiratory Disease (AERD).
Sunday, March 6, 2016: 4:45 PM
Concourse Foyer (Convention Center)
Kristen M Dazy, MD, Jeremy D. Waldram, MD, Jill Waalen, MD, MPH, Katharine M. Woessner, MD FAAAAI, Ronald A. Simon, MD FAAAAI, Andrew White, MD, FAAAAI
Rationale: Aspirin desensitization is effective therapy for AERD and has been successfully and safely performed for hundreds of patients at Scripps Clinic. However, data to predict severe reactions is lacking.

Methods: A chart review of 275 patients with AERD who underwent aspirin desensitization at Scripps Clinic from January 2009 through August 2015 was performed. Of those, 204 met inclusion criteria. Pre-challenge characteristics, such as baseline FEV1, baseline ACT, and medication use were analyzed. Each challenge was reviewed to quantify the reactors, type and severity of reaction, medications used for treatment, and length of desensitization. The data was analyzed to identify characteristics that might predict a severe reaction. 

Results: One hundred sixty-seven (81.8%) patients reacted during challenge, and desensitization was successful in all of them. One hundred forty-seven (88.0%) reacted to nasal ketorolac and 63 (37.7%) to oral aspirin. Naso-ocular reactions were more common among ketorolac reactors. Twenty-one patients were considered severe reactors based on IM epinephrine use or FEV1 drop ≥ 30% and/or ≥ 3 bronchodilator treatments. All severe reactors were successfully desensitized as outpatients. Average length of desensitization was 1.67 days (range: 1 to 4 days). GI reactors required an average of 2.29 days (p=0.006).

Conclusions: Despite undergoing the same aspirin desensitization protocol, approximately 10% of subjects had severe reactions. The likelihood of GI reactions during desensitization is greater if a GI reaction occurred with prior COX-1 inhibitor exposure, but not all patients with a GI reaction during desensitization report such history. A higher baseline SNOT-22 score was associated with more severe reactions (p=0.05).