Work

Factors influencing aspirin therapy after desensitization (ATAD) tolerance in aspirin-exacerbated respiratory disease (AERD) patients

Year: 2025

Type: article

Abstract: BACKGROUND: For more than 40 years, aspirin desensitization with aspirin therapy after desensitization (ATAD) has been a recognized treatment for aspirin-exacerbated respiratory disease (AERD). This study aimed to characterize the rate of ATAD-associated complications leading to discontinuation and identify associated risk factors. OBJECTIVE: To evaluate the rate and causes of ATAD intolerance and identify demographic factors that may predict intolerance in patients with AERD. METHODS: A total of 360 patients with AERD who underwent aspirin desensitization and ATAD at a tertiary center from August 2016 to April 2024 were reviewed. A joint model combining linear mixed and Cox proportional hazards models was used to assess associations between demographic factors, aspirin dosage, and ATAD intolerance. RESULTS: Of 278 patients included, 4 (1.4%) failed desensitization and 44 (15.8%) discontinued ATAD. Furthermore, 10 patients (3.6%) experienced major complications requiring emergency department visit or hospitalization. Common discontinuation causes included gastrointestinal symptoms, anaphylaxis, cutaneous reactions, and airway symptom exacerbation. On average, aspirin dosage decreased overtime (-10 mg daily per month; P < .0001) and was lower in older patients (-7.78 mg daily; P < .0001), reflecting current dosage practices. Peri-/post-menopausal female status was associated with reduced ATAD intolerance risk (hazard ratio [HR] = 0.4; P = .041), whereas pre-menopausal status with a nonsignificant increase (HR = 2.28; P = .087). ATAD intolerance was more likely in Hispanic/Latino (HR = 8.2; P = .0013) and African American patients (HR = 4.03; P = .0015) and increased modestly with age (HR = 1.08; P < .0001). Longitudinal aspirin dosage was not associated with overall intolerance or intolerance due to gastrointestinal complications specifically after adjustment. CONCLUSION: ATAD tolerance was lower in Hispanic/Latino, African American, and older patients, higher in peri-/post-menopausal females, and not associated with longitudinal aspirin dosage.

Source: Annals of Allergy Asthma & Immunology

DOI: 10.1016/j.anai.2025.09.021