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

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

Research output: Contribution to journalArticlepeer-review

Abstract

Aspirin-exacerbated respiratory disease (AERD) is characterized by the clinical triad of chronic rhinosinusitis with nasal polyps, asthma, and an intolerance to medications that inhibit the cycloxgenase-1 enzyme. Patients with AERD on average have more severe respiratory disease compared with patients with chronic rhinosinusitis with nasal polyps and/or asthma alone. Although patients with AERD traditionally develop significant upper and lower respiratory tract symptoms on ingestion of cycloxgenase-1 inhibitors, most of these same patients report clinical benefit when desensitized to aspirin and maintained on daily aspirin therapy. This Work Group Report provides a comprehensive review of aspirin challenges, aspirin desensitizations, and maintenance aspirin therapy in patients with AERD. Identification of appropriate candidates, indications and contraindications, medical and surgical optimization strategies, protocols, medical management during the desensitization, and recommendations for maintenance aspirin therapy following desensitization are reviewed. Also included is a summary of studies evaluating the clinical efficacy of aspirin therapy after desensitization as well as a discussion on the possible cellular and molecular mechanisms explaining how this therapy provides unique benefit to patients with AERD.

Original languageEnglish (US)
Pages (from-to)827-844
Number of pages18
JournalJournal of Allergy and Clinical Immunology
Volume147
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • AERD
  • Aspirin-exacerbated respiratory disease
  • NSAID-exacerbated respiratory disease
  • Samter triad
  • aspirin desensitization

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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