Division of Allergy and Clinical Immunology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
Division of Allergy and Clinical Immunology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
Ann Allergy Asthma Immunol. 2018 Jul;121(1):111-116.e1. doi: 10.1016/j.anai.2018.04.005. Epub 2018 Apr 10.
Aspirin desensitization is an appropriate procedure for many patients with aspirin-exacerbated respiratory disease (AERD). Patients can require aspirin re-dosing, which prolongs the desensitization process. The frequency of this is not widely reported, nor is it known which patients will require multiple re-dosing.
To determine the frequency of and factors associated with repeat aspirin re-dosing during desensitization.
Charts of aspirin desensitization procedures from 2011 to 2016 at the University of Michigan Allergy/Immunology Clinic were reviewed. Reactions with provoking doses and number of dose repetitions were characterized. Previous AERD history, medical history, medications, and baseline spirometry were also recorded. Bivariate correlation and multivariate logistic regression were used to analyze associations between patient characteristics and need for repeated dosing of aspirin.
A total of 84 positive-reacting patients during desensitization were identified. Of these patients, 33% required 2 or more aspirin dose repetitions during desensitization. Requiring 2 or more repeat doses during desensitization was associated with male gender (odds ratio = 6.194, P = .008), forced expiratory volume in 1 second (FEV) decrease during desensitization (odds ratio = 1.075 per percent point drop, P = .021), and initial aspirin provoking dose during desensitization of 81 mg or lower (odds ratio = 11.111, P = .003). No association was found with pre-desensitization medications, asthma severity, AERD duration, or number/character of reported previous aspirin reactions.
During aspirin desensitization for AERD, approximately one third of our patients require multiple repeat doses. Risk factors for multiple repeated doses include male gender, drop in FEV, and lower aspirin provoking doses during desensitization. This information can help inform which patients may require multiple re-dosing for desensitization.
阿司匹林脱敏是许多患有阿司匹林加重性呼吸道疾病（AERD）患者的合适治疗方法。患者可能需要重新服用阿司匹林，这会延长脱敏过程。重复剂量的频率尚未广泛报道，也不知道哪些患者需要多次重复剂量。
确定脱敏过程中重复使用阿司匹林的频率和相关因素。
回顾了 2011 年至 2016 年密歇根大学过敏/免疫学诊所的阿司匹林脱敏程序图表。对激发剂量和剂量重复次数的反应进行了描述。还记录了以前的 AERD 病史、病史、药物和基线肺功能。采用双变量相关和多变量逻辑回归分析患者特征与重复阿司匹林剂量之间的关系。
共确定了 84 名脱敏期间阳性反应的患者。其中，33%的患者在脱敏过程中需要重复使用 2 次或更多次阿司匹林剂量。脱敏过程中需要重复使用 2 次或更多次剂量与男性性别相关（优势比=6.194，P=0.008），脱敏期间用力呼气量（FEV）下降（优势比=每百分点下降 1.075，P=0.021），以及脱敏期间初始阿司匹林激发剂量为 81mg 或更低（优势比=11.111，P=0.003）。未发现与预脱敏药物、哮喘严重程度、AERD 持续时间或之前报告的阿司匹林反应次数和特征相关。
在 AERD 的阿司匹林脱敏过程中，我们约有三分之一的患者需要多次重复剂量。多次重复剂量的风险因素包括男性、FEV 下降和脱敏期间较低的阿司匹林激发剂量。这些信息可以帮助了解哪些患者可能需要多次重复剂量进行脱敏。
