Aspirin Desensitization for NSAID-Exacerbated Respiratory Disease – A Single Centre Experience

Title: Aspirin Desensitization for NSAID-Exacerbated Respiratory Disease – A Single Centre Experience
Author(s): C Ottewill, J Maxwell, S Varghese, S O’Brien, S Lane
Institution: Tallaght University Hospital
Poster: Click to view poster
Category: Asthma and COPD
Abstract: Introduction
Aspirin sensitivity is one of the hallmarks of Samter’s triad, and is present in up to 14% of patients with severe asthma.(1) NSAID-exacerbated respiratory disease (N-ERD) is a chronic, eosinophilic inflammatory condition, occurring in those with asthma, chronic rhino-sinusitis, nasal polyps and symptom exacerbation associated with NSAID use. Aspirin challenge has been established with the aims of both confirming aspirin hypersensitivity in asthma, while aspirin desensitization has been shown to have a role with regard to treatment. (2)

A one-day aspirin challenge and desensitization programme was established in TUH in 2018. Since establishment, this programme has treated 15 patients with an aspirin change and, if successful, subsequent aspirin desensitization. This retrospective cohort study assesses for improvement in symptoms, exacerbation rate, and need for rescue medications following desensitization.

Aspirin desensitization in N-ERD has shown promise as a safe method to reduce symptom burden and glucocorticoid prescription. Initial data from our service, presented at this conference last year showed that 80% of those assessed had a positive aspirin challenge, with 37.5% having clear symptom benefit thereafter.(3) This project seeks to build on previous data, aiming to show that aspirin desensitization reduces symptoms and exacerbation rate in our patient cohort.

1. Laidlaw TM, Boyce JA. Aspirin-Exacerbated Respiratory Disease — New Prime Suspects. Longo DL, editor. N Engl J Med. 2016 Feb 4;374(5):484–8.
2. Kowalski ML, Agache I, Bavbek S, Bakirtas A, Blanca M, Bochenek G, et al. Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)—a EAACI position paper. Allergy. 2019;74(1):28–39.
3. O’Brien S, Breathnach C, Burke S, Lane S. NSAID exacerbated respiratory disease; one day protocol for challenging and desensitising patients using 45 minute intervals. In: IRISH JOURNAL OF MEDICAL SCIENCE. SPRINGER LONDON LTD 236 GRAYS INN RD, 6TH FLOOR, LONDON WC1X 8HL, ENGLAND; 2019. p. 264–265.