Aspirin desensitization for ASA triad patients--prospective study of the rhinologist's perspective

Abstract

OBJECTIVES/PROBLEM: To determine the sinonasal effect of aspirin salicylic acid (ASA) desensitization in patients with nasal polyps, asthma and aspirin intolerance (ASA triad). METHODS OF STUDY: Patients with ASA triad were recruited from the outpatient otolaryngology clinic. They underwent a program of ASA desensitization (2005 - 2008) with prospective assessment of subjective and objective responses. Incremental doses of aspirin were given to reach a target of 625 mg twice daily during a period of 3 - 5 days. A maintenance dose was then given for the study period. The patients also received inhaled and topical nasal steroids, antihistamines and beta agonists for asthma control, but no systemic steroid treatment. MAIN RESULTS: Of the original 27 enrolled subjects, 10 elected to discontinue treatment and five dropped out because of treatment complications. The objective evaluation of the polypoid sinonasal disease in the remaining 12 patients (4 males, 8 females, age range 22 - 63 years) revealed only mild improvement. In contrast, the patients` subjective feeling of nasal congestion, nasal discharge and overall discomfort improved significantly. CONCLUSIONS: Aspirin desensitization has a favorable subjective effect on certain nasal symptoms among ASA triad patients, but the objective effect on polypoid mass is not significant.

Management of chronic rhinosinusitis with nasal polyps in Samter triad by low-dose ASA desensitization or dupilumab

“…[12] Bearing this in mind, we find it logical that studies that have tested considerably higher ASA doses found significant effects on almost every aspect of the disease. [13][14][15][16] However, taking into account the fact that all studies that assessed daily doses of 300 mg [10,12,17] and most studies that assessed daily doses of 100 mg [9,11] still found significant effects, one would always recommend using these relatively low doses. Table 4 gives an overview of the relevant studies addressing oral ASA desensitization.…”

Subgroups in the treatment of nasal polyposis with dupilumab: A retrospective study

“…Acetylsalicylic acid-Desensitization may provide prevention of CRSwNP relapse of sinus surgery. However, these therapies show - depending on their respective dosage - either relatively low efficacy, [ 10 ] may be rich in side effects [ 11 ] and occasionally even both. [ 12 ]…”

“…Acetylsalicylic acid-Desensitization may provide prevention of CRSwNP relapse of sinus surgery. However, these therapies show -depending on their respective dosage -either relatively low efficacy, [10] may be rich in side effects [11] and occasionally even both. [12] Another, relatively new approach is the regular systemic application of dupilumab (DUPIXENT®), humanized monoclonal antibodies that target the IL-4 and IL-13 receptors.…”

Chronische Rhinosinusitis mit Polyposis nasi

“…ASS-Erhaltungstherapie in der vorliegenden Untersuchung beinhaltete aufgrund des retrospektiven Settings eine Dunkelziffer, Nebenwirkungen der Therapie waren aber häufig und alltagsrelevant. Diese Ergebnisse decken sich mit Ergebnissen der Literatur [ 5 , 11 ]. Hinsichtlich des zukünftigen Stellenwerts der ASS-Desaktivierung in Deutschland verbleibt es, auf die Empfehlung der überarbeiteten S2k-Leitlinie der AWMF zu warten.…”