Major complications of aspirin desensitization and maintenance therapy in aspirin‐exacerbated respiratory disease

Abstract

Background Treatment of aspirin-exacerbated respiratory disease AERD includes endoscopic sinus surgery ESS and aspirin desensitization AD with aspirin therapy a er desensitization ATAD The objective of this study was to determine the rate of major complications associated with aspirin use that resulted in the discontinuation of aspirin therapy Methods This study was a retrospective chart review of patients with AERD who underwent ESS AD and ATAD at a single AERD tertiary center between July and February Complications associated with aspirin that resulted in the discontinuation of aspirin therapy were analyzed via analysis of variance and logistic regression Results In total AERD patients underwent ESS with subsequent AD Ten patients discontinued therapy a er AD before starting ATAD Eight patients discontinued therapy a er starting ATAD There were patients with no complications throughout ATAD Reasons for discontinuation included gastritis upper gastrointestinal GI bleed anaphylaxis persistent sinonasal symptoms recurrent epistaxis asthma exacerbation and a nummular rash There was no significant correlation between complication rate and aspirin doses analysis of variance ANOVA F p = gender odds ratio OR confidence interval CI to p = age OR CI to p = or race/ethnicity OR CI to p = Conclusion AD with ATAD was associated with only a incidence of a clinically significant GI bleed and only a incidence of anaphylaxis A remaining patients discontinued aspirin therapy due to minor clinical sequelae These findings demonstrate that the majority of AERD patients tolerate AD with ATAD without any major complications © 2020 ARS-AAOA, LLC.

Demographic Variation in Chronic Rhinosinusitis by Subtype and Region: A Systematic Review

“…Thirty-one articles were included in the final analysis after potentially overlapping studies were excluded. 19–49 Figure 1 provides a summary of the search process. The risk of bias graph is presented as percentages across all included studies and summarized in Figure 2.…”

Baseline Conservative and Surgical Management in the Treatment of NSAID-Exacerbated Respiratory Disease

“…Not all patients tolerate or benefit from ATAD. In the literature, the discontinuation rates vary greatly from 16 to 63% (36,37,41), and therefore alternative treatment options are needed. N-ERD has been considered as a separate asthma phenotype, but it can be divided into several sub-phenotypes with variable clinical characteristics.…”

“…Some major complications, such as clinically significant gastrointestinal bleeding and anaphylaxis, have been reported in ATAD treatment. Other minor reasons for the discontinuation of the treatment include gastritis, persistent sinonasal symptoms, recurrent epistaxis, and asthma exacerbations ( 41 ). Not all patients tolerate or benefit from ATAD.…”

Aspirin desensitization for aspirin‐exacerbated respiratory disease in the era of biologics: Clinical perspective

“…Less than 2% of an ATAD cohort of 109 patients had serious adverse events, with severe GI bleeding requiring treatment occurring in <1%. 7 In addition to preventing polyp regrowth, and therefore further revision surgeries, improving sense of smell, reducing nasal congestion, improving asthma control, and reducing the need for overall corticosteroid use, ATAD provides the ability for patients to use aspirin or nonsteroidal anti-inflammatory drugs for other indications and cardiovascular prophylaxis, and reduces the need for opioid analgesics. 3 Furthermore, ATAD has been shown to improve alcohol tolerance in AERD patients.…”

“…Long‐term ATAD in the AERD population appears to be quite safe. Less than 2% of an ATAD cohort of 109 patients had serious adverse events, with severe GI bleeding requiring treatment occurring in <1% 7 …”