Oral aspirin desensitization instructions and guidelines

ORAL ASPIRIN DESENSITIZATION
INSTRUCTIONS | GUIDELINES | WHAT TO EXPECT DURING DESENSITIZATION Oral aspirin desensitization is usually done to determine whether or not a person is allergic to aspirin, and then whether that person can use daily aspirin therapy to help control symptoms of nasal polyps or asthma. The desensitizations are often done in our BWH Allergy and Immunology clinic at 850 Boylston Street, but in some cases they need to be done at the main hospital campus of Brigham and Women’s Hospital. In preparation for the desensitization, please take all of your usual medications as prescribed, with the following exceptions: 1. If you are taking an oral beta-blocker medication, do NOT take it the day prior to or the 2. If you are taking an oral antihistamine medication, do NOT take it the day prior to or the 3. Your doctor may want you to take one dose of Singulair (montelukast) 10mg the night before the desensitization, and another dose about an hour before the desensitization in the morning. Singulair can help to prevent some of the more severe respiratory/asthma reactions to aspirin. If Singulair is one of your regularly prescribed medications, simply take an extra dose in the morning. If you do not currently have Singulair, contact your doctor and he/she will provide you with the tablets or a prescription for them. 4. If you are currently taking Zyflo (zileuton) or Zyflo CR, your doctor may NOT want you to take it the day prior to or the morning of the desensitization, unless otherwise instructed by your doctor. Taking Zyflo can completely block the entire reaction to aspirin. If your desensitization is scheduled to take place in the allergy clinic, please arrive promptly at your appointment by 7:45am. Once your doctor has met with you briefly, your lung function will be checked with pulmonary function testing (breathing tests). You will be given gradually increasing doses of aspirin to take by mouth (this aspirin will be supplied by the clinic – you do not need to bring aspirin with you), usually every 90 minutes. Pulmonary function tests will be performed throughout the day to ensure that your lung function remains within a safe range. If at any point you feel symptoms of a reaction starting (see possible symptoms below), please let a nurse or your doctor know immediately so that you can be monitored. Depending on the severity of the reaction, you may be given medical treatment (which could include doses of albuterol, Zyflo CR, Benadryl, or oral steroids) and once the reaction has subsided, further doses of aspirin will be given. The goal of the desensitization is usually to have you tolerate a single dose of 325mg of aspirin in the clinic. If this is successful, then the next morning you will begin to take 325mg aspirin (a full “adult” dose) twice a day every day as a therapy. You must take 325-650mg of aspirin twice a day. If you stop the aspirin therapy for more than 1 full day, you may become re-sensitized to it and will need to undergo the desensitization procedure again. You may bring food to the clinic (please do not bring peanut or nut products as many patients in our waiting room are highly sensitive to these foods) and eat and drink anything that you are not allergic to. There is also a small café on the first floor of the 850 Boylston Street clinic that you may go to, as long as the staff is aware that you have left the clinic. You may bring a laptop, a book, a friend, or a hobby to help occupy the time, as it will likely be a long day with a lot of waiting. ORAL ASPIRIN DESENSITIZATION
INSTRUCTIONS | GUIDELINES | WHAT TO EXPECT DURING DESENSITIZATION Patients with Aspirin Exacerbated Respiratory Disease usually develop one or more of the following symptom safter ingesting aspirin. The severity of the reactions varies widely from person-to-person:  Nasal congestion or stuffiness and increased mucous production  Cough, wheezing, or “tightness” in the chest  Nausea and abdominal cramping or abdominal pain Unless otherwise directed by your doctor, please schedule one brief outpatient visit for follow-up 4-6 weeks after the desensitization. If at any point you are concerned or do not feel comfortable with the plan, please feel free to contact your doctor through the outpatient clinic office (617-732-9850). Tanya M. Laidlaw, MD Department of Allergy/Immunology Brigham and Women's Hospital, Boston MA Outpatient Clinic: 617-732-9850 tlaidlaw@partners.org

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