Drug Allergy

Drug Allergy Guidelines (ACAAI/AAAAI)

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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. > 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. , with or 23

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