ASPIRIN DESENSITIZATION AND MAINTENANCE THERAPY IN A NURSING AERD PATIENT

Abstract

Introduction Aspirin exacerbated respiratory disease (AERD) is characterized by upper and lower respiratory symptoms upon ingestion of aspirin and other cyclooxygenase 1 inhibitors. Aspirin is generally not used in pediatric patients due to potential risks, such as the development of Reye's syndrome. There is little data on the safety of aspirin desensitization and aspirin therapy in patients who are nursing. Case Description A nursing 30-year old woman with AERD and a long-standing history of chronic rhinosinusitis, nasal polyps, and asthma was referred by her otolaryngologist for aspirin desensitization. Maximal medical therapy, including leukotriene inhibitors, topical nasal steroids, topical antihistamines, as well as allergen immunotherapy and nasal polyp surgery, were ineffective in controlling the rhinosinusitis and nasal polyps. Total nasal symptom score (TNSSs) involving nasal congestion, sneezing, nasal itch, and nasal drainage at baseline was 12. To minimize infant exposure to aspirin during desensitization, patient had utilized pumped breast milk and infant formula. Patient underwent a two-day protocol of aspirin desensitization, starting with 40.5 mg aspirin through 325 mg. Through consultation with pediatrics, it was decided that patient would be maintained at 81 mg aspirin daily while nursing. Patient responded well with this therapy with TNSSs of 4 at one month, three months, and twelve months after desensitization with no adverse events in child or patient. Discussion Aspirin desensitization and maintenance therapy can be considered in nursing AERD patients after careful assessment of risks and benefits along with pediatric consultation. It can potentially alleviate symptoms of rhinosinusitis, asthma, and nasal polyps.