Long-term treatment with aspirin desensitization: 300 mg aspirin daily is the optimal dose

Approximately 9% of the U.S. population has asthma - 9% of adult asthmatics have aspirin-exacerbated respiratory disease (AERD) (http://goo.gl/FIeE9).

What is the triad of aspirin-exacerbated respiratory disease (AERD)?

Samter's triad include asthma, aspirin sensitivity, and nasal/ethmoidal polyposis.

ASPirin:

Asthma
Sensitivity to aspirin
Polyps

The daily dose of aspirin in desensitization in aspirin-sensitive asthmatics with nasal polyps is still a matter of debate.

This study compared 2 doses of aspirin during the first year of desensitization: either 100 or 300 mg aspirin daily.

The authors concluded that aspirin desensitization followed by 300 mg aspirin daily was efficacious and resulted in polyp-free nasal airways. Aspirin in a dose of 100 mg daily was not sufficient to reduce nasal and bronchial or pulmonary symptoms and to prevent recurrent nasal polyps.

Management of adverse drug reactions: APD or PAD. See more Mind Maps of Drug Hypersensitivity here.

Aspirin Desensitization

Aspirin desensitization should only be done in a monitored environment (hospital) in a patient with FEV1 of at least 70% of predicted.

Example protocol: starting dose is 40.5 mg. The dose is doubled over an interval of 1.5 to three hours until the desired daily dose is met. The patient must take the daily dose indefinitely.

Leukotriene antagonist (LTRA, Singulair) should be initiated prior to the procedure.

Aspirin desensitization can have beneficial effects in patients with aspirin-induced asthma, sinusitis, and can decrease the risk of recurrence of nasal polyps in this population. The desensitized state only lasts as long as daily administration is continued. If a dose is missed, the refractory period may last 48-72 hours.

References:

Long-term treatment with aspirin desensitization: a prospective clinical trial comparing 100 and 300 mg aspirin daily. A. Rozsasi, D. Polzehl, T. Deutschle, E. Smith, K. Wiesmiller, H. Riechelmann, T. Keck. Allergy, Volume 63 Issue 9, Pages 1228 - 1234, 2008.
Sinusitis: A Short Review
Mnemonics: Drug Hypersensitivity
Mind Maps: Drug Hypersensitivity
The Kounis-Zavras syndrome with the Samter-Beer triad http://goo.gl/g7qGh

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