By Daniel W. Todd, MD
Aspirin desensitization is a time tested way to help control chronic inflammation in patients with Aspirin-Exacerbated Respiratory Disease. Sampter’s or Saint’s Triad of Asthma, Nasal Polyps, and ASA sensitivity is a non allergic (non-IgE mediated) cytokine inflammatory cascade triggered by the inhibition of cyclo-oxygenase. Non steroidals and Aspirin can trigger Anaphylactic like reactions. There may be a slight female predilection with no ethnic differences. It seems to hit between the teenage years and middle adulthood.
Aspirin desensitization seems to be helpful in mitigating overall symptoms in the long term. With the advent of Singulair (Leukotriene inhibitors) moving desensitization protocols into the clinic has become reasonably safe. Scripts Clinic has been in the forefront of this therapy. Typically we pretreat the patient with at least 2 weeks of Singulair and Zyrtec. We can use intranasal Ketoralac and then transition into Alkaseltzer dissolvables prior to ASA. We can usually accomplish the densensitization in 1 to 2 days.