Beth Moore can now keep up with her children. The suburban Philadelphia mother of two had suffered from allergies and chronic sinusitis since her teens. With age her symptoms became more severe, turning into bronchitis and eventually asthma, diminishing her ability to breathe and sapping her of her energy. The only complete relief came from aspirin; and the aspirin desensitization that allowed her to overcome her aspirin allergy and end her decades-long battle with sinusitis.
John R. Cohn, MD, head of the Adult Allergy Section at Thomas Jefferson University Hospital and professor of Medicine at Jefferson Medical College of Thomas Jefferson University is one of few allergists to perform the desensitization procedure which trains the body to tolerate aspirin, improving some patients with the triad of sinusitis, asthma, and aspirin-exacerbated respiratory disease (AERD), while allowing others to receive the complete benefits of aspirin for cardiovascular and related disorders.
"Aspirin and nonsteroidal anti-inflammatory drug (NSAID) allergies can cause patients to have life-threatening reactions in the form of asthma, chronic rhinosinusitis or constriction of the upper and lower airways (e.g., nasal congestion and bronchospasm) anywhere from a few minutes to hours after ingestion," Dr. Cohn explains.
Moore recalls her reaction to aspirin as a teenager, "Within minutes I was short of breath and overheating," she says.
Unlike conventional allergies, most aspirin "allergies" are caused by an abnormality in the patient's body chemistry that aspirin aggravates. Desensitization alters the body's chemistry to allow it to tolerate aspirin. For patients with asthma and nasal symptoms, aspirin desensitization can improve their airway disease substantially. The procedure can also benefit cardiac patients, allowing them to take an important preventative drug, as aspirin is commonly prescribed for heart patients, especially after stents are placed.
Physicians have found in recent years that patients like Moore, who previously did not tolerate aspirin saw significant improvement in their sinus and lung conditions when desensitized to aspirin. "Desensitization alters pathways of leukotriene production, improving the patient's tolerance to aspirin and often their underlying disease," says Cohn. Leukotrienes, like histamine, are a family of chemicals made in the body that can cause allergic-like disorders in the nose and chest.
Moore was admitted to Thomas Jefferson University Hospital overnight for the 24-hour desensitization procedure, allowing her to be carefully monitored. She received increasing doses of aspirin at 90-minute intervals beginning with 20.25 mg and working up to 325 mg. Her lung capacity was checked at 90-minute intervals to uncover any adverse reactions. If a dose was not tolerated, she was evaluated and the provoking dose repeated after three hours. "We gradually increase the dose to allow the body to adjust," explains Cohn.
The procedure was a success. Moore now takes 650 mg of aspirin a day and a stomach coater to protect her stomach lining. Her problems with sinusitis and asthma are much improved. She has not had a single infection in the six months since desensitization and has been able to stop most medication.
"The aspirin desensitization gave me back my health, energy and the ability to run and play with my kids that asthma had taken away," said Moore. "Dr. Cohn's aspirin desensitization truly changed my life," she proudly says. "I only wish I had found it sooner."
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