Outpatient Aspirin Desensitization for Patients With Aspirin Hypersensitivity and Cardiac Disease

Abstract

Cardiac disease is common and often treated with aspirin therapy. Patients who develop an immunoglobulin E (IgE) hypersensitivity reaction to aspirin must abort treatment and receive alternative antithrombotic agents. Aspirin desensitization is a therapeutic procedure that may allow patients with a history of hypersensitivity to safely resume aspirin treatment. A variety of inpatient desensitization protocols have been published for IgE-mediated reactions, but outpatient regimens have not been previously reported. We aimed to determine the efficacy and safety of a multiday outpatient aspirin desensitization protocol for patients with an IgE-mediated aspirin hypersensitivity. We retrospectively assessed the efficacy of a multidose aspirin desensitization protocol performed in a university allergy-immunology clinic between July 2006 and December 2009. Patients were referred for a diagnosis of aspirin hypersensitivity and required aspirin for cardiac disease treatment. The protocol involved 10 or 12 aspirin doses depending on the final dose of 81 or 325 mg. Patients were desensitized over 2 to 3 half-days and were able to return home in between desensitization sessions. A total of 9 patients with cardiac disease and aspirin hypersensitivity underwent an outpatient multiday aspirin desensitization. Eight patients (89%) were successfully desensitized and 1 patient declined to continue with further desensitization. No adverse reactions requiring inpatient hospital care occurred during desensitization. This novel outpatient multiday aspirin desensitization protocol was a safe and effective approach for the treatment of aspirin hypersensitivity in patients with cardiac disease who require aspirin therapy. This flexible protocol is convenient for patients by avoiding hospital admission and full-day time commitments.