A 1-Day, 90-Minute Aspirin Challenge and Desensitization Protocol in Aspirin-Exacerbated Respiratory Disease

Abstract

Background: Aspirin challenge and desensitization remains the gold standard in diagnosis and treatment for patients with aspirin-exacerbated respiratory disease (AERD), but the protocols can be time and resource intensive. Objective: To provide evidence that oral aspirin challenge and desensitization can be safely performed in an outpatient setting in one day. Methods: Forty-four patients with a confirmed diagnosis of AERD, stable asthma and baseline FEV1 ≥70% of predicted, completed an oral aspirin challenge and desensitization protocol. The starting dose was 40.5mg with escalating doses of aspirin (81, 162.5, 325mg) at 90-minute intervals until symptoms were provoked. Desensitization was defined as tolerating a repeated administration of the provocative aspirin dose and at least one subsequent dose, bringing the total aspirin ingested during the in-clinic desensitization to ≥325mg. Results: Ninety-three percent of patients completed the challenge and desensitization in one day, with an average protocol completion time of 9 hours and 29 minutes. Two patients (4.6%) chose to complete the protocol over two days. One patient (2.3%) was discontinued from the protocol due to ongoing abdominal discomfort and diarrhea. No patient required epinephrine, emergency department visit or hospitalization.

Aspirin Exacerbated Respiratory Disease: Epidemiology, Pathophysiology, and Management

“…New ASA challenge protocols are continuing to be developed and increase the efficiency of diagnosis. For example, DeGregorio et al recently demonstrated that a one-day ASA challenge utilizing a 90-min dose escalation protocol at a starting dose of 40.5 mg was effective in desensitizing AERD patients with stable asthma and baseline FEV-1 greater than or equal to 70% [53].…”

Sinus surgery improves lower respiratory tract reactivity during aspirin desensitization for AERD

“…Aspirin desensitizations were conducted using a single-day oral challenge protocol. 10 Reasons for more than 1 aspirin desensitization included an intervening pregnancy or surgery that required stoppage of aspirin. Subjects with incomplete spirometry data were excluded.…”

Update on the Management of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity

“…Regimens with shorter dosage intervals (1 to 1.5 hours), a larger starting dose of aspirin (40 mg), and a higher rate of dose escalation have been used for the procedure. They were shown to have similar safety and tolerance profiles; therefore, they can be readily applied in clinical settings 4546. On the other hand, only aspirin OPT can be performed in patients with aspirin/NSAID-induced cutaneous manifestations.…”

“…A modified protocol for aspirin challenge and desensitization was suggested by the EAACI 2019 guideline, consisting of 2 days of ATAD 46. The 1-day ATAD protocol proposed by DeGregorio, et al45 provides a quick alternative for busy patients. Details and time schedules of the two protocols are shown in Table 1.…”