Safety and outcomes of aspirin desensitization for aspirin-exacerbated respiratory disease: a single center study

Publication date: Available online 25 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jeremy Waldram, Kristen Walters, Ronald Simon, Katherine Woessner, Jill Waalen, Andrew White
BackgroundAspirin desensitization is an effective treatment option for aspirin-exacerbated respiratory disease (AERD). Aspirin desensitization protocol modifications have improved the safety and efficiency of this procedure, yet some providers remain reluctant to perform it.ObjectiveThe primary objective of this study was to evaluate the safety and outcomes of outpatient aspirin desensitization procedures. A secondary objective was to assess for clinical characteristics that might predict reaction severity during aspirin desensitization.MethodsTwo hundred seventy-five patients underwent aspirin desensitization at Scripps Clinic between January 2009 and August 2015. Baseline patient characteristics and reaction results were analyzed in the 167 patients who reacted during desensitization.ResultsAll of the 167 reactors, including 23 who were classified as severe reactors, were successfully desensitized in the outpatient setting. The average desensitization duration among reactors was 1.67 days, and the average duration for GI reactors was 2.29 days. Mean baseline SNOT-22 score was higher in severe reactors compared to non-severe reactors (p=.05). Overall, patients on omalizumab had a similar reaction profile to those not on omalizumab.ConclusionsMost patients undergoing aspirin desensitization will develop symptoms. It remains difficult to predict the severity of these symptoms. However, desensitization can be done safely and efficiently in an appropriately equipped outpatient setting. This treatment option should be made available to all patients with AERD. The SNOT-22 score may be able to predict more severe reactions and merits further study. Eight of the 9 patients on omalizumab reacted during desensitization, suggesting that it does not block reactions during aspirin desensitization.Clinical implicationsAspirin desensitization is a relatively safe procedure that may be performed in a properly equipped outpatient setting and it is a treatment option that should be made available to all patients with AERD.



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