Pre treat with 4 weeks of advair or symbicort

Pre treat with singulair (montelukast)10 mg q d for minimum of 2 weeks, consider also treating with Zyflo (Zileutin) 600 mg PO QID for a week prior.

Check FEV1 every hour and should be at least 1.5 L and greater than 60% of predicted

Start with intranasal ketoralac.  given at increasing doses every 1/2 hour over 2 hours followed by a one hour break (See Protocol)

Then start with oral ASA

60 mg asa in 2 doses 1.5 hours apart.  Come back next day to receive 150 mg asa.  3 hour breack adn then 325 mg.  observe.

or

Alka-Seltzer tablets
each dose prepared fresh from one alka seltzer tablet in 100 ml of water.
on tablet in 100 ml or water is 3 mg/ml
a 0.3 mg/ml dose is prepared for the first 3 doses by making a 1:10 dilution (eg. preparing 2 ml added to 18ml of water)
give one dose every 15 minutes.

bill using 95180 per hour.   Should bill out 2-3k—-much better than an inpatient desensitization.