Page 99 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 99
le 2. Aspirin desensitization protocol used effects on nasal polyposis, reducing the need
in University Clinic Golnik. for surgeries and nasal steroid use, however,
there was no effect on NSAID hypersensitiv-
Step Interval (min) Aspirin dose ity17,52. 99
10 1 mg
2 30 2 mg Summary
3 60 4 mg
4 90 8 mg Aspirin, NSAIDs and pyrazolones should be
5 120 16 mg avoided in patients with history of reaction af-
6 150 32 mg ter any of these drugs until allergy workup.
7 180 64 mg Safe alternatives are paracetamol and opioids.
8 210 Most patients tolerate COX-2 inhibitors, but
100 mg this should be confirmed with drug provoca-
tion test.
rhinosinusitis with nasal polyposis. In the first asthma and aspirin exacerbated respiratory disease
case is the target dose of 100 mg of aspirin, In patients with asthma, nasal polyposis
in the second case, the target dose varies from or chronic rhinosinusitis and convincing his-
325 mg up to 1300 mg47,48. In both cases, the tory of multiple reactions to Aspirin, NSAIDs
selected aspirin dose must be taken daily to or pyrazolones, no further diagnostic proce-
maintain tolerance. If the dose is missed for dures are needed and strict avoidance is nec-
more than 48 hours, desensitization must be essary. In patients with chronic urticaria, di-
carried out again. In the majority of the pa- agnostic provocation tests should only be
tients, desensitization is successful, although performed in patients with indication for an-
up to one-quarter of the patients have reac- ti-inflammatory effects of NSAID as in rheu-
tions during the procedure47. Factors associat- matologic diseases.
ed with successful desensitization are female
sex, high blood eosinophil count, low sputum Aspirin is the drug of choice in some
neutrophils, severe nasal symptoms49. If the emergency situations (e.g. acute myocardial
reaction occurs, the patient should be treat- infarction). Patients with history of reaction
ed, and then the desensitization process can after single NSAID and no history of asthma
be continued. The most common long term and/or chronic urticaria, should be offered
adverse effect is gastric irritation. Aspirin provocation test. If Aspirin is tolerat-
ed, patient could be offered further provoca-
Aspirin desensitization in AERD is asso- tion tests with alternative NSAID. In patients
ciated with beneficial effects mainly in symp- with ischemic heart disease and NSAIH hy-
toms of chronic rhinosinusitis. Use of intra- persensitivity, confirmation of tolerance or
nasal corticosteroid and recurrence of nasal desensitization up to 100 mg is usually pos-
polyps are reduced, and there is also less need sible also in patients with asthma or chronic
for revision surgery in these patients. Aspi- urticaria.
rin desensitization is less effective in reducing
asthma symptoms, although one study did Patients with asthma, especially severe
confirm minor improvement in FEV1, symp- asthma and concomitant nasal symptoms and
tom and medication score46,50. unknown tolerance to Aspirin, NSAID and
pyrazolones should be warned of the poten-
There are several studies researching the tial for development of AERD later in life.
effect of biological therapies on AERD with
various outcomes. Omalizumab, anti-IL5 References
treatment, and dupilumab do have clinical
1. Widal F, Abrami P, Lermoyez J. First
complete description of the aspirin idi-
osyncrasy-asthma-nasal polyposis syn-
in University Clinic Golnik. for surgeries and nasal steroid use, however,
there was no effect on NSAID hypersensitiv-
Step Interval (min) Aspirin dose ity17,52. 99
10 1 mg
2 30 2 mg Summary
3 60 4 mg
4 90 8 mg Aspirin, NSAIDs and pyrazolones should be
5 120 16 mg avoided in patients with history of reaction af-
6 150 32 mg ter any of these drugs until allergy workup.
7 180 64 mg Safe alternatives are paracetamol and opioids.
8 210 Most patients tolerate COX-2 inhibitors, but
100 mg this should be confirmed with drug provoca-
tion test.
rhinosinusitis with nasal polyposis. In the first asthma and aspirin exacerbated respiratory disease
case is the target dose of 100 mg of aspirin, In patients with asthma, nasal polyposis
in the second case, the target dose varies from or chronic rhinosinusitis and convincing his-
325 mg up to 1300 mg47,48. In both cases, the tory of multiple reactions to Aspirin, NSAIDs
selected aspirin dose must be taken daily to or pyrazolones, no further diagnostic proce-
maintain tolerance. If the dose is missed for dures are needed and strict avoidance is nec-
more than 48 hours, desensitization must be essary. In patients with chronic urticaria, di-
carried out again. In the majority of the pa- agnostic provocation tests should only be
tients, desensitization is successful, although performed in patients with indication for an-
up to one-quarter of the patients have reac- ti-inflammatory effects of NSAID as in rheu-
tions during the procedure47. Factors associat- matologic diseases.
ed with successful desensitization are female
sex, high blood eosinophil count, low sputum Aspirin is the drug of choice in some
neutrophils, severe nasal symptoms49. If the emergency situations (e.g. acute myocardial
reaction occurs, the patient should be treat- infarction). Patients with history of reaction
ed, and then the desensitization process can after single NSAID and no history of asthma
be continued. The most common long term and/or chronic urticaria, should be offered
adverse effect is gastric irritation. Aspirin provocation test. If Aspirin is tolerat-
ed, patient could be offered further provoca-
Aspirin desensitization in AERD is asso- tion tests with alternative NSAID. In patients
ciated with beneficial effects mainly in symp- with ischemic heart disease and NSAIH hy-
toms of chronic rhinosinusitis. Use of intra- persensitivity, confirmation of tolerance or
nasal corticosteroid and recurrence of nasal desensitization up to 100 mg is usually pos-
polyps are reduced, and there is also less need sible also in patients with asthma or chronic
for revision surgery in these patients. Aspi- urticaria.
rin desensitization is less effective in reducing
asthma symptoms, although one study did Patients with asthma, especially severe
confirm minor improvement in FEV1, symp- asthma and concomitant nasal symptoms and
tom and medication score46,50. unknown tolerance to Aspirin, NSAID and
pyrazolones should be warned of the poten-
There are several studies researching the tial for development of AERD later in life.
effect of biological therapies on AERD with
various outcomes. Omalizumab, anti-IL5 References
treatment, and dupilumab do have clinical
1. Widal F, Abrami P, Lermoyez J. First
complete description of the aspirin idi-
osyncrasy-asthma-nasal polyposis syn-
