Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Division of Allergy and Immunology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Ann Allergy Asthma Immunol. 2017 Mar;118(3):333-338.e1. doi: 10.1016/j.anai.2016.11.021. Epub 2017 Jan 5.
The frequency with which patients with aspirin-exacerbated respiratory disease (AERD) react to 325 mg of aspirin during aspirin desensitization, or fail to react at all, is not fully known.
To determine the rate and type of reaction at 325 mg of aspirin during desensitization.
A retrospective study of 104 patients who underwent aspirin desensitization from 2010 to 2016 was performed. A standard desensitization protocol (starting at 20-40 mg, progressing through 325 mg, and extinguishing reactions by dose repetition) was used. Reactions were defined by upper respiratory tract symptoms, lower respiratory tract symptoms, and/or forced expiratory volume in 1 second decrease of 15% or greater. Patients who did and did not react were compared by logistic regression.
Eighty-four patients reacted (81%) and 20 did not (19%). Seventy-seven patients who had a provoking reaction at 162 mg of aspirin or less subsequently extinguished their reactions before they reached a dose of 325 mg and had no problems at that dose; one subsequent 325-mg reaction occurred during a protocol violation. One initial provoking reaction to 325 mg occurred. Both 325-mg reactions were mild, and neither met the forced expiratory volume in 1 second criterion for a clinically meaningful change. The remaining 5 patients could not complete the protocol because of persistent reactions or social reasons. Reactors were more likely to have had asthma for more than 10 years than nonreactors (odds ratio, 3.2; 95% confidence interval, 1.0-10.3; P = .05).
During aspirin desensitization for AERD, provoking reactions at the 325-mg dose are rare (1%) and mild. Patients who react at 162 mg or less and extinguish their reactions may be able to administer the 325-mg dose at home.
在阿司匹林脱敏过程中，阿司匹林加重呼吸疾病（AERD）患者对 325 毫克阿司匹林的反应频率，或者根本没有反应，目前还不完全清楚。
确定脱敏过程中 325 毫克阿司匹林的反应率和类型。
对 2010 年至 2016 年接受阿司匹林脱敏的 104 例患者进行回顾性研究。使用标准脱敏方案（从 20-40 毫克开始，通过 325 毫克进展，并通过剂量重复消除反应）。反应定义为上呼吸道症状、下呼吸道症状和/或用力呼气量第 1 秒减少 15%或更多。通过逻辑回归比较反应者和无反应者。
84 例患者有反应（81%），20 例无反应（19%）。77 例在 162 毫克或以下的阿司匹林激发反应后，在达到 325 毫克剂量之前消除了反应，且在该剂量下无问题；1 例随后在违反方案期间发生 325 毫克反应。有 1 例初始 325 毫克激发反应。这两个 325 毫克的反应都很轻微，都没有达到用力呼气量第 1 秒的临床意义变化标准。其余 5 例因持续反应或社会原因无法完成方案。反应者比无反应者更有可能患有哮喘超过 10 年（比值比，3.2；95%置信区间，1.0-10.3；P =.05）。
在 AERD 的阿司匹林脱敏过程中，325 毫克剂量的激发反应很少见（1%）且温和。在 162 毫克或以下反应并消除反应的患者，可能能够在家中使用 325 毫克剂量。
