Aspirin Desensitization in Two Patients with Refractory Urticaria, Positive Chronic Uritcaria Index, and Elevated Mast Cell Mediators

Rationale: Aspirin is generally avoided in patients with chronic urticaria (CU). Aspirin desensitization (AD) has been used in Mast Cell Activation Syndrome (MCA), and Systemic  Mastocytosis (SM) to stabilize symptoms.  We hypothesize that patients with refractory CU, positive chronic urticaria index (CUI) and elevated Mast Cell Mediators (MCM), may benefit from aspirin desensitization. 

Methods:  Two patients with refractory chronic urticaria and elevated chronic urticaria index (CUI), negative tryptase, and elevated 11- Beta Prostaglandin F-2-alpha, and one patient with elevated leukotriene E4; underwent aspirin desensitization with the Wong protocol, and were continued on doses of 325 mg - 650 mg of aspirin two or three times daily.

Results: Both patients reported improvement in symptoms with a decrease in the number and severity of flares. Previous medications were weaned as tolerated. Patients were also able to decrease anti-histamine intake by 25-50%. 

Conclusions: Aspirin desensitization may help to control chronic urticaria and decrease medication therapy in these patients. Larger studies will be needed to confirm these findings.