Desensitization with asa a successful treatment for a patient with aspirin exacerbated respiratory disease

The presence of bronchial asthma, chronic rhinosinusitis (CRS) with nasal polyps, and a hypersensitivity reaction of the airway to aspirin (acetylsalicylic acid–ASA), as well as other non-selective inhibitors of the cyclooxygenase enzyme (COX),1‒3 commonly characterizes the Aspirin-exacerbated respiratory disease (AERD). It is within the broad spectrum of hypersensitivity reactions induced by non-steroidal anti-inflammatory drugs (NSAIDs), in minutes after administration. The prevalence of AERD is unknown, although, it is estimated that it can affect between 5.5% and 12.4% of the general population.4 The exact prevalence of nasal polyps is not known. However, it is estimated that it can be around 100%.5,6 For the diagnosis, the clinical history of hypersensitivity reaction, exacerbation type of asthma or secondary rhinitis to the consumption of NSAIDs is highly suggestive of AERD, especially if there is the presence of anosmia and nasal polyps. Provocation with inhibitors of COX,7‒9 makes the confirmation. This challenging test is mainly performed with aspirin, although protocols with other NSAIDs such as ketorolac also exist.5 The administration route can be oral, nasal, bronchial and intravenous inhalation.10,11