Aspirin Desensitization For AERD

An accidental discovery made a few decades ago revolutionized the treatment of Aspirin Exacerbated Respiratory Disease (asthma, nasal polyps, aspirin sensitivity).  In patients with this syndrome,  a single dose of aspirin (or other nonsteroid anti-inflammatory drugs) causes an acute worsening of sinus and asthma symptoms yet a program of gradual introduction of aspirin, followed by a maintenance regimen actually helps to improve the condition over time. It is not clear why this works but for some patients the response is dramatic.  It is not possible to predict who will respond to the treatment but it’s usually worth trying in someone who has more severe disease (frequent surgeries for recurrent nasal polyps or severe asthma requiring oral steroids).  After aspirin desensitization many patients need less oral steroids and fewer sinus surgeries.   Prior to the advent of certain medications (leukotriene modifiers) this was considered high risk and was often done in hospital but now for many patients this is an in-office procedure and quite well tolerated.  The ideal time to do this is soon after sinus surgery when most of the nasal polyps have been removed.  

Benefits of aspirin desensitization:

  • Improved asthma symptoms and fewer asthma attacks
  • Reduced need for medications to treat respiratory symptoms
  • Better sense of smell and taste
  • Slower regrowth of nasal polyps and fewer polyp surgeries

Process of aspirin desensitization:

  • premedication with prophylactic medications (for asthma and allergy as needed)
  • starts slow at a very low dose (20-40 mg) of aspirin
  • gradually higher doses of aspirin are given every couple of hours
  • frequent examinations and monitoring of lung function testing
  • as needed treatment for side effects
  • Final maintenance dose of 650 mg twice daily (total of 4 adult aspirin daily).

During the procedure symptoms are likely to occur and may include:

  • Nasal congestion, sneezing, runny nose, sinus pain
  • Itchy red eyes, tearing 
  • Cough, wheezing, or “tightness” in the chest

On occasion during desensitization, there may be:

  • Hives, rash
  • Nausea or abdominal pain

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