Rational approach to aspirin dosing during oral challenges and desensitization of patients with aspirin-exacerbated respiratory disease

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:123

Article

Hope, Andrew P.^1,2,3  Woessner, Katharine A.^2,3  Simon, Ronald A.^2,3  Stevenson, Donald D.^2,3 

[1] Kaiser Permanente Santa Clara, Dept Allergy, Santa Clara, CA 95051 USA

[2] Scripps Clin, Div Allergy Asthma & Immunol, La Jolla, CA 92037 USA

[3] Scripps Res Inst, La Jolla, CA 92037 USA

关键词: Aspirin;    asthma;    aspirin-exacerbated respiratory disease;    sinusitis;    polyps;    oral challenge;    drug allergy;    drug desensitization;   

DOI  :  10.1016/j.jaci.2008.09.048

来源: Elsevier

【 摘 要 】

Background: Aspirin desensitization improves clinical outcomes in most patients with aspirin-exacerbated respiratory disease. Most protocols for desensitization are time-consuming. Objective: Our objective was to use historical information about the course of aspirin desensitization to enhance the efficiency of the desensitization protocol. Methods: Four hundred twenty subjects with suspected aspirin-exacerbated respiratory disease underwent oral aspirin challenges. Their clinical characteristics were analyzed in relation to features of reactions during aspirin challenges. Results: Large (FEV1 decrease >30%) and moderate (FEV1 decrease 21% to 30%) bronchial reactions occurred in 9% and 20% of subjects, respectively. Multivariate analysis identified risk factors associated with these larger reactions, including lack of leukotriene modifier use, baseline FEV1 of less than 80% of predicted value, and previous asthma-related emergency department visits. Seventy-five percent of patients reacted to a provoking dose of either 45 or 60 mg. Only 3% of initial reactions occurred after 150- or 325-mg provoking doses, and none occurred after the 650-mg dose. Conclusions: Most bronchial and naso-ocular reactions during oral aspirin challenges occurred within a narrow dosing range (45-100 mg). Only 1 of 26 patients without risk factors had a moderate reaction. (J Allergy Clin Immunol 2009;123:406-10.)

【 授权许可】

Free