From the Guidelines
Aspirin desensitization therapy is typically initiated with a low dose of aspirin, such as 20-40 mg, administered orally or intranasally, and gradually increased every 2-3 days to achieve a target dose of 325-650 mg twice daily 1.
Desensitization Protocol
The desensitization protocol usually involves a 5-7 day regimen, with doses escalated as follows: 20-40 mg on day 1,40-80 mg on day 2,80-162 mg on day 3, and 325 mg on day 4, with subsequent increases to 325 mg twice daily by day 7 1.
Monitoring and Maintenance
Patients are closely monitored for signs of allergic reactions, such as respiratory symptoms, rash, or gastrointestinal upset, during the desensitization process 1.
- Daily administration of at least 325 mg of aspirin once daily is required for patients to remain in a tolerant state 1.
- Higher doses are usually necessary to control nasal polyps and airway inflammation with initial doses of 650 mg twice daily being necessary for optimal effect 1.
- Gaps in aspirin doses >48 hours may lead to loss of tolerance and after 5 days all patients will react to aspirin and require another desensitization procedure to resume therapy 1.
Pretreatment and Considerations
- Leukotriene-modifying agents have been found to diminish the lower respiratory asthmatic response during aspirin desensitization and, therefore, are recommended as pretreatment for patients with AERD preparing for aspirin desensitization who are not already taking one of these agents (when not otherwise contraindicated) 1.
- Inhaled corticosteroid/long-acting beta agonist inhalers serve a dual purpose of optimizing asthma control prior to desensitization but also diminishing the severity of NSAID-induced bronchospasm and, therefore, should also be considered for pretreatment 1.
From the Research
Aspirin Desensitization Therapy Process
The process of aspirin desensitization therapy involves a series of escalating doses of aspirin administered over a period of time to help patients with aspirin-exacerbated respiratory disease (AERD) or aspirin hypersensitivity tolerate the medication. The goal of desensitization is to allow patients to take aspirin safely and effectively for its anti-inflammatory and antiplatelet effects.
Desensitization Protocols
Different desensitization protocols have been developed, including:
- A 1-day, 90-minute aspirin challenge and desensitization protocol, starting with a dose of 40.5 mg and escalating to 325 mg or more 2
- An hourly dose-escalation protocol, which can be completed in a single day or over 2 days 3
- A multiday outpatient aspirin desensitization protocol, involving 10 or 12 aspirin doses over 2 to 3 half-days 4
- A protocol starting with 650 mg twice daily, with the option to decrease to 325 mg twice daily based on symptom control 5
Key Considerations
- Patients with AERD or aspirin hypersensitivity should undergo desensitization under the supervision of a healthcare professional in a clinical setting.
- The desensitization process typically involves administering escalating doses of aspirin, with monitoring for signs of reaction or intolerance.
- The frequency and severity of reactions during desensitization can vary, but most reactions are mild and can be managed with dose adjustment or temporary discontinuation of the protocol 6
- Successful desensitization can allow patients to take aspirin safely and effectively, improving symptom control and reducing the need for alternative medications.
Dosing and Administration
- The starting dose and escalation schedule may vary depending on the protocol and individual patient factors.
- Common dosing regimens include 40.5 mg, 81 mg, 162.5 mg, and 325 mg, with escalation intervals ranging from 30 minutes to 90 minutes.
- Patients who complete desensitization successfully may be able to take aspirin at home, with ongoing monitoring and follow-up to ensure continued tolerance and effectiveness.