Journal article
Factors influencing aspirin therapy after desensitization (ATAD) tolerance in aspirin-exacerbated respiratory disease (AERD) patients
Annals of allergy, asthma, & immunology, v 136(3), pp 288-294
01 Mar 2026
PMID: 41022281
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.
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Details
- Title
- Factors influencing aspirin therapy after desensitization (ATAD) tolerance in aspirin-exacerbated respiratory disease (AERD) patients
- Creators
- Lancelot P. Herpin - University of PennsylvaniaAlexa M. Finuoli - University of PennsylvaniaAlan D. Workman - Massachusetts Eye and Ear InfirmarySi Hao Tang - Drexel UniversityKrithika Kuppusamy - University of PennsylvaniaMichael A. Kohanski - University of PennsylvaniaJames N. Palmer - University of PennsylvaniaNithin D. Adappa - University of PennsylvaniaJennifer E. Douglas - University of PennsylvaniaJohn V. Bosso - University of Pennsylvania
- Publication Details
- Annals of allergy, asthma, & immunology, v 136(3), pp 288-294
- Number of pages
- 7
- Grant note
- University of Pennsylvania (http://data.elsevier.com/vocabulary/SciValFunders/100006920)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine; Otolaryngology (and Head and Neck Surgery)
- Web of Science ID
- WOS:001709102000001
- Scopus ID
- 2-s2.0-105024956672
- Other Identifier
- 991022197018704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Allergy
- Immunology