LA JOLLA, CALIF—In patients with aspirin-exacerbated respiratory disease (AERD), topical, inhaled, or systemic corticosteroids are often necessary to control inflammatory symptoms. The literature has shown that AERD patients can achieve desensitization after one year of daily aspirin therapy. However, a recent study of 38 patients with AERD has demonstrated that a program of aspirin desensitization reduces AERD symptoms within four weeks.[1]

The study took place at the General Clinic Research Center of the Scripps Clinic in La Jolla, California. All patients had a history of asthma induced by nonsteroidal anti-inflammatory drugs. Twenty-six patients were being treated with nasal corticosteroids, and 32 were receiving inhaled corticosteroids. Six were using a daily leukotriene antagonist. Fifteen patients were taking oral prednisone—either daily or every other day—during the month before desensitization. These patients were instructed to decrease their prednisone dose after the desensitization program began, if they could do so without increasing their symptoms.

Following challenge with a placebo, lung function stability was assessed, forced expiratory volume in one second (FEV1) was measured, and nasal scores were obtained. If a patient’s asthma was considered stable, aspirin challenges were started.

DESENSITIZATION

During oral aspirin challenges, all patients experienced respiratory reactions; the mean dose that incited a reaction was 58 mg of aspirin. Symptoms included naso-ocular reactions and bronchial reactions, which were defined as a decrease in FEV1 of 15% or more. After symptoms were treated and had cleared, the challenge was repeated. The dose of aspirin was increased over several days until 650 mg could be tolerated without any adverse symptoms. After aspirin desensitization, all patients were instructed to take 650 mg of aspirin twice daily and were discharged from the research center.

All patients filled out daily diary cards during the four weeks before and the four weeks after desensitization. The cards were used to record the incidence of nasal and asthma symptoms, as well as the daily corticosteroid doses. The severity of nasal and asthma symptoms was gauged on a scale of 1 to 5 (1 = no symptoms; 5 = extremely severe symptoms). Sense of smell was recorded using a similar scale.

SYMPTOM IMPROVEMENT SEEN EARLY

All patients experienced highly significant improvements in total nasal and asthma symptoms as well as olfactory scores following desensitization. In addition, the 15 patients who were taking oral prednisone were able to significantly lower their mean daily dose. Eight patients reduced their dosage by at least 50%, and two of the five patients who had been taking prednisone every other day discontinued it entirely.

“[Aspirin] desensitization is effective in reducing important markers of disease activity in AERD patients as early as the first month of treatment,” the study authors concluded.

—Gale Jurasek