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The use of aspirin desensitization therapy may reduce symptoms of rhinosinusitis and improve overall quality of life for people with aspirin exacerbated respiratory disease (AERD), an aggressive type of sinusitis, according to a new study. However, the study also found that desensitization therapy was linked to an increase in adverse events, which include asthma exacerbation, gastritis, and other side effects that may lead to patients abandoning treatment.

Researchers synthesized the findings of several recent studies – five randomized controlled trials and two observational studies – with a total of 233 AERD patients. The trials all compared oral aspirin desensitization versus no desensitization (placebo) for the treatment of AERD.

The study, a systematic review and meta-analysis, was recently published in the journal International Forum of Allergy & Rhinology.

AERD occurs in approximately 7 percent of the estimated 2.4 million Canadians who suffer from asthma, usually developing between ages 30 and 40. Patients with AERD are more likely to have severe uncontrolled asthma, and tend to have higher morbidity compared to those with aspirin-tolerant asthma. This leads to more frequent emergency room visits and surgical interventions, as well as a higher reliance on corticosteroids by AERD patients.

Aspirin desensitization therapy has been used to treat symptoms associated with AERD, though indications of its safety and efficacy were based on observational studies alone. The treatment involves administering increasing doses of aspirin over hours to days to build tolerance. A maintenance dose must be taken regularly, as desensitization effects can be lost in as little as 48 hours.

In addition to the benefits of aspirin desensitization on upper respiratory symptoms and disease-related quality of life, the study noted additional benefits that include reduced nasal polyp recurrence, improved sense of smell, improved alcohol tolerance, and decreased use of corticosteroids. However, it stressed the significantly increased risk of adverse events that is largely absent from clinical guidelines.

“These findings give a more complete picture of the risks and benefits of aspirin desensitization for AERD” said Dr. Derek Chu, lead author of the study. “Our meta-analysis focused on more reliable randomized controlled trials, as opposed to single-arm studies, and has important implications for shared decision making with patients. They also help put aspirin desensitization in context with alternative and emerging therapies for patients, clinicians, researchers and guideline and policy developers.”

Dr. Chu (pictured) is a Clinical Scholar in Allergy & Immunology at McMaster University, and a clinician-scientist at St. Joseph’s Healthcare Hamilton.

The researchers also suggest that large, well-conducted clinical trials are needed to further clarify the precise effects of aspirin desensitization versus no desensitization, and to determine the optimal dose, duration, and patient characteristics that would optimize safety and efficacy.

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