The value of aspirin desensitisation in the management of asthma and rhinosinusitis: Evidence–based

Background:  Aspirin is one of the gold standard medications used in a wide range of therapeutic and preventive indications. Aspirin hypersensitivity is a non-direct immunological mediated allergic reaction. It is responsible for aspirin exacerbated airway disease (AERD) and can cause asthma, rhinosinusituis, nasal polyps, urticaria and angioedema. The prevalence of aspirin hypersensitivity is 2.5 %⁽¹⁾  Aspirin Desensitisation (AD) has to be used for treating such cases. Aim : In this review, we evaluated and rated the available evidence-based data for the value of AD on asthma and rhinosinusitis. Methods:  An electronic search of databases; PubMed, Cochran's database and American college of physicians. Results: 393 publications were relevant to AD. Duplicated, non-human and non-English language references were excluded. Papers of unclear objectives and outcomes were excluded. The remaining 44 papers have evidence on the value of AD for management of asthma and rhinosinusitis. The evaluation was based on diagnosis, efficacy, failure, safety and cost-effectiveness. Level of evidence (L) was rated according to a new scheme of oxford Centre of Evidence-based Medicine (CEBM)⁽²⁾. According to EACCI/GA2LEN 2007 guidelines for diagnosis of aspirin hypersensitivity, aspirin provocation challenge tests are recommended for diagnosis of aspirin induced asthma, and rhinosinusitis. AD is an effective treatment option and may alter the course of the ARED in patients with ARED who require aspirin for other therapeutic indications. Evidence is from five randomised controlled trials (LII), one small retrospective, one prospective study, three systematic review of non-randomised trials and one cross over study (LIII), 21 case reports, expert opinion and clinical experience (LV). AD is a safe treatment with low aspirin dosage (LV, LIII) and high dose (LII). It is a cost effective option in cardiovascular diseases (LIII). In spite of the confirmed efficacy of AD, there is some failures (LV).Conclusion: AD has a small evidence data base, however, based on current available evidence AD is effective, safe and an alternative option for AERD patients. AD might be a cost effective option for cardiovascular diseases. More randomised multicentre controlled trials are needed in AERD.