Table 9. Apirin Induction of Drug Tolerance, Aspirin Desensitization Joint Task Force Recommendationsa
> FEV1
> Consider starting or continuing leukotriene modifier therapy > Start or continue treatment with high-dose inhaled corticosteroid and long-acting β-agonist if poorly controlled asthma > Systemic steroid burst if low FEV1
Assessment and Premedication (within one week before procedure) > 70% predicted
> If patient is undergoing maintenance systemic steroids, consider doubling daily dose (if on alternate-day steroids change to daily dose)
or bronchial instability Protocol
Time, min 0
90
180 270 360
> Establish intravenous access. > Conduct FEV1
Aspirin Dose, mg 20.25 40.5 81
162.5 325
> Document informed consent and advise patient it may take several days to complete (most will take 2 days).
> Extend dosing interval to 3 hours based on individual patient characteristics. > Reactions will likely occur with early doses, usually 81 mg. > Treat reactions as indicated below. > After patient completely stabilized (but not less than 3 hours after the last dose), repeat provoking dose as desired. A persistent > 15% decrease in FEV1
and clinical assessment every 90 minutes and with symptoms. , with or
> If nasal, gastrointestinal, or cutaneous reactions occur on day 1, pretreat with histamine1
and histamine2
Ocular Nasal
Laryngeal Bronchial receptor antagonists for remainder of procedure.
Medications for Treatment of Aspirin-induced Reactions Oral antihistamines
Oral antihistamine, topical decongestant
Racemic epinephrine nebulization and/or intramuscular epinephrine
β-Agonists
Urticaria/angioedema Oral or intravenous antihistamines Hypotension
Parenteral epinephrine
a This recommended protocol is intended to be more practical, using doses based on commercially available 81 mg aspirin products and a shorter dosing interval. There are no data on safety and efficacy of this protocol.
without associated symptoms, lasting longer than 3 hours despite therapy, is an indication to discontinue the desensitization process for the day.
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