Aspirin Desensitization

How will I know if I am Sensitive to Aspirin?

Patients that are sensitive to aspirin can show the following symptoms:

  •         Hives
  •         Itching
  •         Swelling
  •         Shortness of Breath or wheezing
  •         Worsening of nasal/sinus symptoms

 

 

What is Aspirin-Exacerbated Respiratory Disease (AERD)?

Aspirin-exacerbated respiratory disease (AERD) is a condition that includes chronic asthma, sinusitis with nasal polyps, and sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Patients with this condition can experience mild to severe respiratory symptoms for aspirin-related medications. Some of these other medications can include ibuprofen and naproxen. About 1 in 10 patients with asthma or 1 in 3 patients with asthma plus sinusitis with nasal polyps have the possibility to have a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs which results in having AERD.

 

What is Aspirin Desensitization?

Aspirin Desensitization is a procedure for patients with Aspirin-exacerbated respiratory disease (AERD) which can generate a tolerance to aspirin. For patients with life-threatening respiratory conditions, they can also undergo the procedure and end up being able to take aspirin or aspirin-related medications, without having an allergic reaction to it.

 

What Are the Benefits of Aspirin Desensitization?

Aspirin desensitization allows a patient to gain the following benefits:

  •         Decreased corticosteroid doses
  •         Improved asthma control
  •         Delayed regrowth of nasal polyps causing less sinus related surgeries (polyp surgeries)
  •         Tolerance to aspirin (ASA) and non-steroidal anti-inflammatory drugs NSAIDs
  •         Less requirement for medication to treat respiratory symptoms
  •         Improved sense of smell and taste

 

How Successful is Aspirin Desensitization?

Clinical studies show that aspirin desensitization approximately 87% of patients experienced improvements in symptoms, which allowed the patient to reduce the use of steroid and other medications. During aspirin desensitization, the patient must use daily aspirin dosages to reduce their symptoms of asthma, nasal polyps and sinusitis.

 

What are the Risks of Aspirin Desensitization?

The dose of aspirin that is given during aspirin desensitization is much smaller than what is taken in most cases. The reactions due to a lower dose are usually less severe, in most cases than the reaction a patient would have experienced with taking a full dose. The most severe risk of aspirin desensitization is developing a life-threatening asthma exacerbation. Other symptoms could include:

  •         Nasal Congestion
  •         Runny Nose
  •         Tightness in the Throat
  •         Stomach Pain
  •         Nausea
  •         Heartburn
  •         Hives
  •         Rarely, a Drop in Blood Pressure

 

Your Physician closely monitors you, your vital signs, oxygen intake, and lung function for up to three hours after each dose that has been given. When and if a reaction occurs, the procedure is then stopped. To relieve the symptoms, your physician will use inhalation treatments, nasal sprays, oral medication, and/or medication injections.

 

What Should I Expect During the Aspirin Desensitization?

During the aspirin desensitization, the patient is, in most cases, only submitted in the outpatient clinic during the day. In rare cases when there has been a severe reaction, or the patient has severe asthma, the patient could be admitted for closer monitoring.

At the beginning of the treatment, a patient will be given a low dose of aspirin (20-40 mg). This dose is then gradually increased to a higher does, about an hour and a half to three hours after the first dose. The protocol for each patient is always different depending on the symptoms and severity of their reactions. During a reaction the patient could experience one or more of the following:

  •         Increased nasal congestion
  •         Eye-watering, itchiness or redness
  •         Frontal headache or sinus pain
  •         Headache or pain/pressure in the face
  •         Cough, wheezing, or “tightness” in the chest

In rare occasions, the patient could experience the following reactions:

  •         Hives
  •         Rash
  •         Flushing of the face and upper body
  •         Nausea and abdominal cramping or pain

 

During the process, you will be monitored by your physician and nurses. They will evaluate your lung function by recording your peak expiratory flow by using a breathing test. This test is performed by you breathing into a mouthpiece that is attached to a recording device.

If you have an aspirin-induced reaction, you will be given medication to stabilize the symptoms. Once the reaction is calmed down you will then be given another dose of aspirin, starting with the amount that caused the reaction. In most to all cases there will usually be no additional reaction if the same dose is repeated.

The desensitization process will be complete once you have reached 325 mg of aspirin without any reaction. You will then be able to go home and continue with the 325 mg dose twice a day, depending on your case.

 

Is Aspirin Desensitization Safe?

Aspirin desensitization is a safe process, even if you have a bad reaction. When a patient is experiencing a severe reaction, they are treated quickly and effectively to reverse the symptoms. The long-term risks of aspirin therapy can include:

  •         Abdominal pain
  •         Abdominal bleeding
  •         Stomach ulcers

 

Taking an antacid medication can result in helping any stomach pain. Aspirin can limit blood clotting, which means that the patient can bruise easier and bleed longer if cut or during surgery. If you experience more than normal bleeding that won’t stop, you should stop taking aspirin immediately.

 

What do I Need to do Prior to Aspirin Desensitization?

One week prior to your aspirin desensitization testing, your asthma must be stable. Your doctor could also recommend medications that will help block the clinical effects of those leukotrienes, such as Singulair and Zyflo CR.

  •         Have a light breakfast.
  •         Continue all regular medications as scheduled unless otherwise directed.
  •         Do not use any antihistamines or decongestants 48 hours prior to arrival.
  •         Continue all asthma medications but try to avoid Albuterol or any other short-acting bronchodilator medications 8 hours prior to the testing.

 

How Long Will the Testing Take?

The aspirin desensitization takes the full day over two or three days. Arrive early as directed by the medical staff. Where you will be in the hospital for the entire day bring books, laptop, snacks and/or other activities.

 

What if I Miss a Dose, Am I Still Desensitized?

You can miss a dose for a maximum of 48 hours. If a dose is missed only take your usual dosage. After 48 hours of missing your medication, your body can begin to lose the desensitized state. If you take aspirin after this window, there is the possibility that you could have a reaction. Call your doctor for instructions if a dose is missed for 48 hours or more.

If you have missed a dose for 3-5 days, you will need to come into the office and be monitored as you receive a dose of 325mg of aspirin. Beyond 5 days of missing your medication, you will need to start the process from the beginning.

 

Am I a Candidate for Aspirin Desensitization?

Candidates for aspirin desensitization must be in 1 of the following 3 categories:

  •         Aspirin-sensitive patients with asthma who are experiencing uncontrolled respiratory inflammation.
  •         Aspirin-sensitive patients requiring repeated sinus surgeries.
  •         Aspirin-sensitive patients who need aspirin or NSAIDs for the treatment of other diseases.

 

Who is Not a Candidate for Aspirin Desensitization?

Aspirin desensitization is not for the following:

  •         Patients who had aspirin-induced hives or anaphylaxis that don’t require daily aspirin therapy for treatment of other conditions.
  •         Women who are pregnant or planning to get pregnant.

 

When should I call my healthcare provider?

You should call your doctor if you have gone 48 hours or longer without taking your aspirin or if you are experiencing any of the following symptoms, caused by a bad reaction to aspirin:

  •         Hives
  •         Problems swallowing
  •         Swelling of the lips or tongue
  •         Belly pain
  •         Nausea or throwing up

 

Learn More About Aspirin Desensitization Today

Contact your local Atlanta, GA allergist and asthma professional, Dr. Thomas Chacko at (770) 475-3361 or e-mail us using our online form. We have five locations for your convenience, including Atlanta, Cummings, Duluth, Johns Creek and Roswell.