D1.370 - Desensitisation to low-dose acetylsalicylic acid in NERD. Clinical follow-up of aspirin therapy after desensitisation (ATAD)

Aspirin-exacerbated respiratory disease (AERD/NERD) represents a relevant epidemiological and clinical burden, affecting approximately 5% of the general population and up to 25% of patients with asthma. In real-life clinical practice, management is often heterogeneous and poorly adherent to current guidelines among ENT specialists, allergologists and pulmonologists. In particular, long-term topical intranasal corticosteroid therapy before and after endoscopic sinus surgery is frequently underused. Aspirin desensitisation followed by continuous aspirin therapy, although recommended by EPOS 2020, remains largely underutilised in Italy compared with other European countries and the United States.

We consecutively evaluated 62 patients referred to our outpatient clinic and diagnosed with NERD according to current clinical criteria (Kowalski et al., 2013). Aspirin desensitisation was proposed to all eligible patients and performed in 40 subjects, while 6 additional patients accepted the procedure after initial refusal. Maintenance doses were 100 mg in 29 patients, 300 mg in 11 patients and 600 mg in 1 patient. Only 31/62 patients were receiving intranasal corticosteroids, before of enrolment in the study and continuous treatment was documented in 23 cases. Continuation of treatment with intranasal corticosteroids was a condition for enrolment in the study. Asthma was present in 58 patients (GINA 1: n=2; GINA 2: n=1; GINA 3: n=40; GINA 4: n=13; GINA 5: n=2). Fifteen patients were treated with biologics (omalizumab n=3, mepolizumab n=3, benralizumab n=4, dupilumab n=6).

Aspirin desensitisation resulted in clinical improvement of hyposmia, nasal obstruction and/or asthma symptoms in 20 patients. Five patients did not tolerate the procedure (gastrointestinal symptoms n=2, asthma exacerbation n=1, urticaria n=1). Drop-out occurred in six cases.

Low-dose aspirin desensitisation appears clinically effective in the majority of NERD patients, with adverse events occurring in approximately 10%, mainly at higher doses. Drop-out rates remain relevant, largely due to poor treatment adherence. The therapeutic effect appears synergistic with concomitant biologic therapies.