A One-day, 90-minute Aspirin Challenge and Desensitization Protocol in Aspirin-Exacerbated Respiratory Disease

Abstract

Aspirin challenge and desensitization remains the gold standard in diagnosis and treatment of patients with aspirin-exacerbated respiratory disease (AERD), but the protocols can be time and resource intensive. The objective of this study is to provide evidence that oral aspirin challenge and desensitization can be safely performed in an outpatient setting in one day. Forty-four patients with 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 dose and at least one subsequent aspirin dose, bringing total aspirin ingested during the in-clinic desensitization to ≥325mg. 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 on-going abdominal discomfort and diarrhea. No patient required epinephrine, emergency department visit or hospitalization. Patients with AERD on a stable asthma regimen and with a baseline FEV1≥70% can be safely desensitized to aspirin using a 90-minute dose escalation protocol, starting at a dose of 40.5mg, and defining desensitization as tolerance of the repeated provocation dose and at least one subsequent aspirin dose, bringing total cumulative daily dose to ≥325mg. This protocol can routinely be completed in one day.