gms | German Medical Science

81. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V.

12.05. - 16.05.2010, Wiesbaden

Threshold-adapted aspirin desensitization – a new method in the treatment of aspirin induced nasal polyposis

Meeting Abstract

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German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Wiesbaden, 12.-16.05.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10hno098

DOI: 10.3205/10hno098, URN: urn:nbn:de:0183-10hno0987

Veröffentlicht: 6. Juli 2010

© 2010 Mühlmeier et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Nasal polyposis is defined as a subentity of chronic sinusitis and often leads to surgery after initial attempts of conservative treatment. As both regimens reflect symptomatic treatment, nasal polyposis tends to numerous relapses. The affected patients are over-proportionally intolerant to salicylates.

28 patients (equal female and male, 27 to 67 years of age) with salicylate intolerance assured by either nasal challenge or definite anamnesis received titrated intravenous ASA challenge after exclusion of medium or high grade bronchial asthma. The challenge was stopped in case of starting bronchial reaction or without any reactions at 500 mg.

Nasal thresholds of ASA reactions were found at 173 mg ± 82 mg (median 154 mg). 19 patients (68%) showed pharyngeal reactions at 176 mg ± 90 mg, 12 patients (43%) cutaneous reactions at 205 mg ± 61 mg and 19 patients (68%) beginning bronchial reactions at 261 mg ± 106 mg of Lysine-ASS. One patient, who did not stop the infusion while reaching the bronchial threshold at 117 mg, was prophylactically surveyed in the intensive care unit for one night. Due to the identified thresholds 2 patients were dosed up to 100 mg, 7 to 200 mg, 12 to 300 mg, 6 to 400 mg and one to 500 mg of daily ASA administration.

For the first time, the identified thresholds show the different levels of sensitivity to ASA and furthermore the intra-individual sensitivity of the affected organs. This new method of threshold-adapted ASA desensitization represents a safe procedure and may explain the therapeutic lack in about 20 to 30% of patients who do not succeed from conventional desensitization with a static ASA dosage of 300 mg.