Aspirin desensitization in aspirin intolerance: update on current standards and recent improvements

This review provides an overview of sensitivity to aspirin (acetylsalicylic acid) and its management. In particular, it focuses on current standards and recent improvements in aspirin desensitization. Recent publications on various desensitization protocols and routes of administration are discussed.

The incidence of aspirin hypersensitivity in the general population ranges from 0.6-2.5%, but that in adult asthmatics ranges from 4.3-11%. Carefully controlled challenge tests with aspirin or other non-steroidal anti-inflammatory drugs are performed as the diagnostic tool of choice. Aspirin desensitization therapy has demonstrated therapeutic effects. Various protocols and routes of administration have been elaborated in the last two decades. Oral administration by means of an initial desensitization with incremental doses of aspirin, followed by daily high-dose therapy, has proven clinical efficacy and safety. Immunological mechanisms of aspirin desensitization therapy are also discussed.

The full clinical picture of aspirin intolerance--the association of aspirin-induced bronchial asthma (with severe acute asthma attacks), aspirin sensitivity and nasal polyps--is commonly summarized as the 'Samter triad'. This condition is related to the abnormal metabolism of arachidonic acid, implicating both the lipoxygenase and the cyclooxygenase pathways. Knowledge concerning mechanisms and clinical features of aspirin intolerance has grown rapidly in recent years. Research has focused on new strategies of aspirin desensitization therapy, especially oral administration using high-dosage protocols.