The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma &amp; Immunology

Stevens, Whitney W.; Jerschow, Elina; Baptist, Alan P.; Borish, Larry; Bosso, John V.; Buchheit, Kathleen M.; Cahill, Katherine N.; Campo, Paloma; Cho, Seong H.; Keswani, Anjeni; Levy, Joshua M.; Nanda, Anil; Laidlaw, Tanya M.; White, Andrew A.

doi:10.1016/j.jaci.2020.10.043

Cited by 88 publications

(67 citation statements)

References 148 publications

(240 reference statements)

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“…Available protocols suggest administration of 40 mg, 80, mg, 160, mg, and 325 mg every 60 to 90 minutes, until the patient is able to tolerate a dose of 325 mg of aspirin. Following aspirin desensitization, aspirin maintenance therapy is initiated, commonly with twice daily dose of 650 mg followed by tapering to 325 mg twice daily ( 145 , 146 ). Clinically, N-ERD patients treated with aspirin maintenance regimens experience a reduction in their daily need for maintenance corticosteroid, improvement in clinical symptoms of asthma, and experience a significant reduction in ER visits or hospitalization due to asthma ( 16 , 20 , 147 , 148 ).…”

Section: Treatment Of N-erdmentioning

confidence: 99%

Aspirin Actions in Treatment of NSAID-Exacerbated Respiratory Disease

et al. 2021

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Non-steroidal Anti-inflammatory drugs (NSAID)-exacerbated respiratory disease (N-ERD) is characterized by nasal polyposis, chronic rhinosinusitis, adult-onset asthma and hypersensitive reactions to cyclooxygenase-1 (COX-1) inhibitors. Among the available treatments for this disease, a combination of endoscopic sinus surgery followed by aspirin desensitization and aspirin maintenance therapy has been an effective approach. Studies have shown that long-term aspirin maintenance therapy can reduce the rate of nasal polyp recurrence in patients with N-ERD. However, the exact mechanism by which aspirin can both trigger and suppress airway disease in N-ERD remains poorly understood. In this review, we summarize current knowledge of aspirin effects in N-ERD, cardiovascular disease, and cancer, and consider potential mechanistic pathways accounting for the effects of aspirin in N-ERD.

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Section: Treatment Of N-erdmentioning

confidence: 99%

Aspirin Actions in Treatment of NSAID-Exacerbated Respiratory Disease

et al. 2021

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“…There are multiple published challenge and desensitization protocols, all of which are effective at achieving their diagnostic or therapeutic goal. 1 To maximize safety, cysLT 1 receptor antagonist pretreatment is used to attenuate the aspirin-induced decline in FEV 1 . The collection of biospecimens during standardized aspirin challenge and/or desensitization protocols has been foundational to our current understanding of the unique immunology of AERD.…”

Section: Aspirin Challenge and Desensitizationmentioning

confidence: 99%

“…Clinicians and researchers have capitalized on these unique respiratory reactions to COX-1 inhibitors to establish the diagnosis of AERD, differentiate the unique inflammatory state of AERD from aspirintolerant asthma (ATA) or chronic rhinosinusitis with nasal polyposis, and achieve a state of desensitization to initiate daily aspirin therapy. The clinical benefits of high-dose (325-1300 mg daily) aspirin therapy in AERD are well established and have been recently summarized by Stevens et al 1 Here, we will review our current understanding of the immunologic impact of aspirin exposure during desensitization and daily high-dose therapy in AERD.…”

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confidence: 98%

Immunologic effects of aspirin desensitization and high-dose aspirin therapy in aspirin-exacerbated respiratory disease

Cahill

2021

Journal of Allergy and Clinical Immunology

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“…Since its first description in 1980 [4], several blinded and longitudinal studies have consistently shown the benefit of ATAD including a decrease in sinonasal symptoms (Grade 1A), decrease in intranasal corticosteroid use (Grade 2B), reduction in recurrence of nasal polyps (Grade 2B), and decrease in the need for revision surgery (Grade 2B) [1]. According to the American Academy of Allergy, Asthma and Immunology, ATAD is a "unique treatment option that should be considered in all eligible patients with AERD as a means to improve clinical outcomes and delay or prevent future sinus surgery" [5]. The majority of N-ERD sufferers would benefit from ATAD [5].…”

Section: Introductionmentioning

confidence: 99%

“…According to the American Academy of Allergy, Asthma and Immunology, ATAD is a "unique treatment option that should be considered in all eligible patients with AERD as a means to improve clinical outcomes and delay or prevent future sinus surgery" [5]. The majority of N-ERD sufferers would benefit from ATAD [5]. However, there are some patients who cannot tolerate ATAD because of associated symptoms affecting the skin, gut or lungs.…”

Section: Introductionmentioning

confidence: 99%

A retrospective study on long-term efficacy of intranasal lysine-aspirin in controlling NSAID-exacerbated respiratory disease

Pendolino

Scadding

Scarpa

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Aspirin treatment after desensitization (ATAD) represents an effective therapeutic option suitable for NSAID-exacerbated respiratory disease (N-ERD) patients with recalcitrant disease. Intranasal administration of lysine-aspirin (LAS) has been suggested as a safer and faster route than oral ATAD but evidence for its use is less strong. We investigated nasal LAS therapy long-term efficacy based on objective outcomes, smell function, polyp recurrence and need for surgery or rescue therapy. Clinical biomarkers predicting response to intranasal LAS, long-term side effects and consequences of discontinuing treatment have been evaluated. Methods A retrospective analysis of a database of 60 N-ERD patients seen between 2012 and 2020 was performed in March 2021. They were followed up at 3-months, 1-, 2- and 3-years with upper and lower airway functions assessed at each follow-up. Results Higher nasal airflow and smell scores were found at each follow-up in patients taking LAS (p < 0.001 and p = 0.048 respectively). No influence of LAS on pulmonary function measurements was observed. Patient on intranasal LAS showed a lower rate of revision sinus surgery when compared to those who discontinued the treatment (p < 0.001). None of the variables studied was found to influence LAS treatment response. Conclusion Our study demonstrates the clinical effectiveness of long-term intranasal LAS in the management of N-ERD in terms of improved nasal airflow and olfaction and a reduced need for revision sinus surgery. Intranasal LAS is safe, being associated with a lower rate of side effects when compared to oral ATAD. However, discontinuation of the treatment at any stage is associated with a loss of clinical benefit.

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The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma & Immunology

Cited by 88 publications

References 148 publications

Aspirin Actions in Treatment of NSAID-Exacerbated Respiratory Disease

Aspirin Actions in Treatment of NSAID-Exacerbated Respiratory Disease

Immunologic effects of aspirin desensitization and high-dose aspirin therapy in aspirin-exacerbated respiratory disease

A retrospective study on long-term efficacy of intranasal lysine-aspirin in controlling NSAID-exacerbated respiratory disease

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