Lancelot P Herpin, Alexa M Finuoli, Alan D Workman, Si Hao Tang, Krithika Kuppusamy, Michael A Kohanski, James N Palmer, Nithin D Adappa, Jennifer E Douglas, John V Bosso
{"title":"影响阿司匹林加重呼吸系统疾病（AERD）患者脱敏（ATAD）耐受性后阿司匹林治疗的因素","authors":"Lancelot P Herpin, Alexa M Finuoli, Alan D Workman, Si Hao Tang, Krithika Kuppusamy, Michael A Kohanski, James N Palmer, Nithin D Adappa, Jennifer E Douglas, John V Bosso","doi":"10.1016/j.anai.2025.09.021","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>For over 40 years, aspirin desensitization (AD) 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.</p><p><strong>Objective: </strong>To evaluate the rate and causes of ATAD intolerance and identify demographic factors that may predict intolerance in AERD patients.</p><p><strong>Methods: </strong>360 AERD patients who underwent AD 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.</p><p><strong>Results: </strong>Of 278 patients included, four (1.4%) failed desensitization, and 44 (15.8%) discontinued ATAD. 10 patients (3.6%) experienced major complications requiring ED 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 < 0.0001) and was lower in older patients (-7.78 mg daily; p < 0.0001), reflecting current dosage practices. Peri-/post-menopausal female status was associated with reduced ATAD intolerance risk (HR = 0.4; p = 0.041), while pre-menopausal status showed a non-significant increase (HR = 2.28; p = 0.087). ATAD intolerance was more likely in Hispanic/Latino (HR = 8.2; p = 0.0013) and African American patients (HR = 4.03; p = 0.0015), and increased modestly with age (HR = 1.08; p < 0.0001). Longitudinal aspirin dosage was not associated with overall intolerance or intolerance due to gastrointestinal complications specifically after adjustment.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":" ","pages":""},"PeriodicalIF":4.7000,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Factors Influencing Aspirin Therapy after Desensitization (ATAD) Tolerance in Aspirin-Exacerbated Respiratory Disease (AERD) Patients.\",\"authors\":\"Lancelot P Herpin, Alexa M Finuoli, Alan D Workman, Si Hao Tang, Krithika Kuppusamy, Michael A Kohanski, James N Palmer, Nithin D Adappa, Jennifer E Douglas, John V Bosso\",\"doi\":\"10.1016/j.anai.2025.09.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>For over 40 years, aspirin desensitization (AD) 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.</p><p><strong>Objective: </strong>To evaluate the rate and causes of ATAD intolerance and identify demographic factors that may predict intolerance in AERD patients.</p><p><strong>Methods: </strong>360 AERD patients who underwent AD 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.</p><p><strong>Results: </strong>Of 278 patients included, four (1.4%) failed desensitization, and 44 (15.8%) discontinued ATAD. 10 patients (3.6%) experienced major complications requiring ED 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 < 0.0001) and was lower in older patients (-7.78 mg daily; p < 0.0001), reflecting current dosage practices. Peri-/post-menopausal female status was associated with reduced ATAD intolerance risk (HR = 0.4; p = 0.041), while pre-menopausal status showed a non-significant increase (HR = 2.28; p = 0.087). ATAD intolerance was more likely in Hispanic/Latino (HR = 8.2; p = 0.0013) and African American patients (HR = 4.03; p = 0.0015), and increased modestly with age (HR = 1.08; p < 0.0001). Longitudinal aspirin dosage was not associated with overall intolerance or intolerance due to gastrointestinal complications specifically after adjustment.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":50773,\"journal\":{\"name\":\"Annals of Allergy Asthma & Immunology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2025-09-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Allergy Asthma & Immunology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.anai.2025.09.021\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ALLERGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Allergy Asthma & Immunology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.anai.2025.09.021","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}
Factors Influencing Aspirin Therapy after Desensitization (ATAD) Tolerance in Aspirin-Exacerbated Respiratory Disease (AERD) Patients.
Background: For over 40 years, aspirin desensitization (AD) 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 AERD patients.
Methods: 360 AERD patients who underwent AD 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, four (1.4%) failed desensitization, and 44 (15.8%) discontinued ATAD. 10 patients (3.6%) experienced major complications requiring ED 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 < 0.0001) and was lower in older patients (-7.78 mg daily; p < 0.0001), reflecting current dosage practices. Peri-/post-menopausal female status was associated with reduced ATAD intolerance risk (HR = 0.4; p = 0.041), while pre-menopausal status showed a non-significant increase (HR = 2.28; p = 0.087). ATAD intolerance was more likely in Hispanic/Latino (HR = 8.2; p = 0.0013) and African American patients (HR = 4.03; p = 0.0015), and increased modestly with age (HR = 1.08; p < 0.0001). 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.
期刊介绍：
Annals of Allergy, Asthma & Immunology is a scholarly medical journal published monthly by the American College of Allergy, Asthma & Immunology. The purpose of Annals is to serve as an objective evidence-based forum for the allergy/immunology specialist to keep up to date on current clinical science (both research and practice-based) in the fields of allergy, asthma, and immunology. The emphasis of the journal will be to provide clinical and research information that is readily applicable to both the clinician and the researcher. Each issue of the Annals shall also provide opportunities to participate in accredited continuing medical education activities to enhance overall clinical proficiency.
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