Improvement in aspirin-sensitive asthmatic subjects after rapid aspirin desensitization and aspirin maintenance (ADAM) treatment

Abstract

Twelve ASA-sensitive (AS) asthmatics, including nine over age 35 years and three under age 19, were successfully desensitized to the adverse effects of ASA in an average of 322 min without any serious untoward sequelae. Six subjects (50%) experienced subjective improvement, three (25%) no change, and three (25%) worsening in their asthma while on a daily maintenance dose of ASA (mean = 539 mg) for an average follow-up period of 115 days. Six subjects (50%) were able to discontinue one or more antiasthma medications, including systemic steroid in one (8%) and aerosol steroid in three (25%). The incidence of subjective improvement in asthma status (67% vs. 44%) was higher in those under 19 than in those over 35, and none of the younger vs. 30% of the older subgroup experienced worsening in their asthma. ASA desensitization (AD) followed by an ASA maintenance program (ADAM) therefore appeared to be beneficial in approximately 50% of AS asthmatics. In this study an improvement in postdesensitization peak expiratory flow rate with a repeat ASA challenge appeared to correlate best with subjective improvement in asthma and/or reduction in antiasthma medication requirement after AD. However, the number of subjects studied was relatively small and the conclusions drawn will require confirmation.