Factors Correlated with Repeated Aspirin Dosing during Aspirin Desensitization

Abstract

Abstract Background Aspirin desensitization is an appropriate procedure for many patients with aspirin-exacerbated respiratory disease (AERD). Patients can require aspirin re-dosing, which prolongs the desensitization process. The frequency of this is not widely reported, nor is it known which patients will require multiple re-dosing. Objective To determine the frequency of and factors associated with repeat aspirin re-dosing during desensitization. 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. Prior AERD history, medical history, medications, and baseline spirometry were also recorded. Bivariate correlation and multivariate logistic regression were used to analyze associations between patient characteristics and need for repeated dosing of aspirin. Results A total of 84 positive reacting patients during desensitization were found. 33% of these patients required two or more aspirin dose repetitions during desensitization. Requiring two or more repeat doses during desensitization was associated with male gender (odds ratio=6.194, p=0.008), FEV1 decrease during desensitization (odds ratio=1.075 per percent point drop, p=0.021), and initial aspirin provoking dose during desensitization of 81 mg or lower (odds ratio=11.111, p=0.003). No association was found with pre-desensitization medications, asthma severity, AERD duration, or number/character of reported prior aspirin reactions. Conclusion During aspirin desensitization for AERD, approximately 1/3 of our patients require multiple repeat doses. Risk factors for multiple repeated doses include male gender, drop in FEV1, and lower aspirin provoking doses during desensitization. This information can help inform which patients might require multiple re-dosing for desensitization.