Factors Correlated with Repeated Aspirin Dosing during Aspirin Desensitization
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Charles F Schuler IV, MD, James L. Baldwin, MD FAAAAI, Alan P. Baptist, MD MPH FAAAAI
RATIONALE: Aspirin desensitization is an appropriate procedure for many patients with aspirin-exacerbated respiratory disease (AERD). Patients can require aspirin re-dosing, which can prolong the desensitization process. The frequency of this has not been widely reported, nor is it known which patients will require multiple re-dosing.

METHODS: Charts of aspirin desensitization procedures from 2011-2016 at the University of Michigan Allergy/Immunology Clinic were reviewed. Reactions with provoking doses and number of dose repetitions were characterized as upper and lower reactions. Prior AERD history, medical history, medications, and baseline spirometry were also recorded. SPSS was used for statistical analysis of associations between patient characteristics and need for repeated dosing of aspirin, and logistic regression analysis was then performed.

RESULTS: A total of 84 positive reactions during desensitization were found. 32% of these patients required more than one aspirin dose repetition during desensitization. Requiring 2 or more repeat doses during desensitization was associated with male gender (odds ratio = 5.277, p = 0.015), FEV1 decrease during desensitization (odds ratio = 1.086 per percent point drop, p = 0.009), and initial aspirin provoking dose during desensitization of 81 mg or lower (odds ratio = 10.085, p = 0.026). No association was found with pre-desensitization medications, AERD duration, or prior aspirin reactions.

CONCLUSIONS: During aspirin desensitization for AERD, approximately 1/3 of patients require multiple repeated doses. Risk factors for multiple repeated doses include male gender, a drop in FEV1, and lower aspirin provoking doses during desensitization. This can help inform which patients might require multiple re-dosing for desensitization.