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Aspirin Desensitization and High-Dose Aspirin Therapy in Aspirin-Exacerbated Respiratory Disease

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Practical Medical and Surgical Management of Chronic Rhinosinusitis

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Abstract

The management of chronic rhinosinusitis with nasal polyps associated with aspirin-exacerbated respiratory disease (AERD) has historically been variable, and the symptoms are usually refractory to common therapies. Aspirin desensitization followed by high-dose aspirin therapy has been shown to improve asthma and sinus symptoms scores, decrease corticosteroid use, and reduce rates of revision sinus surgery with 70–80 % of patients with AERD reporting benefit. Aspirin desensitization is safely performed in the outpatient setting by specialists trained in asthma and allergic diseases with experience in performing aspirin desensitization and the capability to treat anaphylaxis. Both the procedure of desensitization and the high-dose aspirin therapy have low rates of adverse events and have been shown to be cost-effective. The mechanism by which high-dose aspirin provides clinical benefits remains unknown, and clinicians currently are not able to predict which patients will respond to the therapy. High-dose aspirin therapy is indicated for patients who are refractory to standard medical therapy, require frequent bursts of oral steroids, or have recurrent nasal polyps, an indication which captures the majority of patients with AERD. Thus, as a safe and effective treatment option for patients with AERD, aspirin desensitization is now considered part of the mainstay in management of patients with AERD.

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Author information

Authors and Affiliations

  1. Department of Medicine/Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital/Harvard Medical School, 1 Jimmy Fund Way, Boston, MA, 02115, USA

    Katherine N. Cahill MD

  2. Department of Allergy and Immunology, Brigham and Women’s Hospital, 1 Jimmy Fund Way, Boston, MA, 02115, USA

    Kathleen Buchheit MD

  3. Department of Allergy and Immunology, University of Virginia Health System, 801355, Charlottesville, VA, 22908, USA

    Carolyn Word MD

  4. Department of Medicine (Allergy and Immunology) and Microbiology, University of Virginia Health System, 801355, Charlottesville, VA, 22908, USA

    Larry Borish MD

Authors
  1. Katherine N. Cahill MD
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  2. Kathleen Buchheit MD
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  3. Carolyn Word MD
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  4. Larry Borish MD
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Corresponding author

Correspondence to Larry Borish MD .

Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Pete S. Batra

  2. Department of Otolaryngology and Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA

    Joseph K. Han

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Cahill, K.N., Buchheit, K., Word, C., Borish, L. (2015). Aspirin Desensitization and High-Dose Aspirin Therapy in Aspirin-Exacerbated Respiratory Disease. In: Batra, P., Han, J. (eds) Practical Medical and Surgical Management of Chronic Rhinosinusitis. Springer, Cham. https://doi.org/10.1007/978-3-319-16724-4_19

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  • DOI: https://doi.org/10.1007/978-3-319-16724-4_19

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-16723-7

  • Online ISBN: 978-3-319-16724-4

  • eBook Packages: MedicineMedicine (R0)

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