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Clinical Reviews in Allergy & Immunology

, Volume 24, Issue 2, pp 159–167 | Cite as

Aspirin desensitization in patients with AERD

  • Donald D. Stevenson
Article

Abstract

All patients with aspirin exacerbated respiratory disease (AERD) can be desensitized to ASA. After achieving this state, patients can then take ASA daily without adverse effect. ASA desensitization can be maintained indefinitely as long as the patient takes ASA each day. Crossdesensitization with older NSAIDs also occurs. After ASA desensitization, patients can take daily ASA in order to treat their underlying respiratory disease. In AERD patients treated with ASA 650 BID for at least a year, 115/172 (67%) improved in their clinical courses while decreasing systemic and topical corticosteroids. Sixteen failed to improve, 24 stopped ASA because of intractable side effects (gastritis or hives) and 17 patients discontinued ASA treatment in the first year of study for unrelated reasons. Therefore, treatment with daily ASA is a significant therapeutic option for patients afflicted with AERD. It should be used for AERD patients who do not respond to topical corticosteroids and leukotriene modifier drugs. Those who respond to systemic steroids or have intractable or recurrent nasal polyps are particularly well-suited for this therapeutic intervention.

Index Entries

Aspirin (ASA) nonsteroidal antiinflammatory drug (NSAID) aspirin-exacerbated respiratory disease (AERD) general clinical research center (GCRC) 

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References

  1. 1.
    Stevenson, D., Sánchez-Borges, M., and Szczeklik, A. (2001), Classification of allergic and pseudo-allergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann. Allergy Asthma Immunol. 87, 177–180.PubMedCrossRefGoogle Scholar
  2. 2.
    Stevenson, D., and Simon, R. A. Sensitivity to aspirin and nonsteroidal antiinflammatory drugs, in Allergy: Principles and Practice. Middleton, Jr., E., Ellis, E. F., Yunginger, J. W., Reed, C. E., Adkinson, N. F., Jr., and Busse, W. W., eds., vol. 2, 5th ed. Mosby, St. Louis, 1998, pp. 1225–1234.Google Scholar
  3. 3.
    Zeiss, C. R., and Lockey, R. F. (1976), Refractory period to aspirin in a patient with aspirin-induced asthma. J. Allergy Clin. Immunol. 57, 440–448.PubMedCrossRefGoogle Scholar
  4. 4.
    Bianco, S. R. M., and Petrini, G. (1977), Aspirin induced tolerance in aspirin-asthma detected by a new challenge test. IRCS J. Med. Sci. 5, 129–136.Google Scholar
  5. 5.
    Stevenson, D. D., Simon, R. A., and Mathison, D. A. (1980), Aspirin-sensitive asthma: tolerance to aspirin after positive oral aspirin challenges. J. Allergy Clin. Immunol. 66, 82–88.PubMedCrossRefGoogle Scholar
  6. 6.
    Pleskow, W. W., Stevenson, D. D., Mathison, D. A., Simon, R. A., Schatz, M., and Zieger, R. S. (1982), Aspirin desensitization in aspirin sensitive asthmatic patients: clinical and manifestations and characterization of the refractory period. J. Allergy Clin. Immunol. 69, 11–19.PubMedCrossRefGoogle Scholar
  7. 7.
    Stevenson, D. (1999), Oral desensitization to aspirin. AIANE 1–4.Google Scholar
  8. 8.
    Stevenson, D. D. Drug-induced asthma, in Asthma, Slavin, R. and Reisman, R. E., eds., vol. 1. American College of Physicians, Philadelphia, 2002, pp. 191–208.Google Scholar
  9. 9.
    Chiu, J. T. (1983), Improvement in aspirin-sensitive asthmatic subjects after rapid aspirin desensitization and aspirin maintenance (ADAM) treatment. J. Allergy Clin. Immunol. 71(6), 560–567.PubMedCrossRefGoogle Scholar
  10. 10.
    Lumry, W. R., Curd, J. G., Zieger, R. S., Pleskow, W. W., and Stevenson, D. D. (1983), Aspirin-sensitive rhinosinusitis: the clinical syndrome and effects of aspirin administration. J. Allergy Clin. Immunol. 71, 580–587.PubMedCrossRefGoogle Scholar
  11. 11.
    Stevenson, D. D., Pleskow, W. W., Simon, R. A., Mathison, D. A., Lumry, W. R., Schatz, M., et al. (1984), Aspirin-sensitive rhinosinusitis asthma: a double-blind cross-over study of treatment with aspirin. J. Allergy Clin. Immunol. 73, 500–507.PubMedCrossRefGoogle Scholar
  12. 12.
    Nelson, R. P., Stablein, J. J., and Lockey, R. F. (1986), Asthma improved by acetylsalicylic acid and other nonsteroidal anti-inflammatory agents. N. Engl. Reg. Allergy Proc. 7, 117–121.PubMedCrossRefGoogle Scholar
  13. 13.
    Kowalski, M., Grzelewska-Rzymowska, I., Szmidt, M., and Rozniecki, J. (1986), Clinical efficacy of aspirin in “desensitized” aspirin-sensitive asthmatics. Eur. J. Respir. Dis. 69, 219–225.PubMedGoogle Scholar
  14. 14.
    Sweet, J. A., Stevenson, D. D., Simon, R. A., and Mathison, D. A. (1990), Long term effects of aspirin desensitization treatment for aspirin sensitive rhinosinusitis asthma. J. Allergy Clin. Immunol. 86, 59–65.CrossRefGoogle Scholar
  15. 15.
    Stevenson, D. D., Hankammer, M. A., Mathison, D. A., Christensen, S. C., and Simon, R. A. (1996), Long term ASA desensitization-treatment of aspirin sensitive asthmatic patients: clinical outcome studies. J. Allergy Clin. Immunol. 98, 751–758.PubMedCrossRefGoogle Scholar
  16. 16.
    Naeije, N., Bracamonte, M., Michel, O., et al. (1984), Effects of chronic aspirin ingestion in aspirin-intolerant asthmatic patients. Ann. Allergy 53, 262–264.PubMedGoogle Scholar
  17. 17.
    Berges-Gimeno, M. P., Simon, R. A., and Stevenson, D. D. (2003) Treatment with aspirin desensitization in aspirin exacerbated respiratory disease. J. Allergy Clin. Immunol. (Accepted for publication.)Google Scholar

Copyright information

© Humana Press Inc 2003

Authors and Affiliations

  • Donald D. Stevenson
    • 1
  1. 1.Division of Allergy, Asthma, and ImmunologyScripps Clinic and the Scripps Research InstituteLa Jolla

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