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Aspirin desensitization for aspirin‐exacerbated respiratory disease in the era of biologics: Clinical perspective
Author(s) -
Bosso John V.
Publication year - 2021
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22709
Subject(s) - rhinology , medicine , otorhinolaryngology , general surgery , family medicine , surgery
We read with great interest Dr Bosso’s recent correspondence.1 In that communication he nicely describes the emergence of aspirin therapy after desensitization (ATAD), as type 2 biologics represent highly promising therapies in the treatment of our most recalcitrant patients. The rate of surgical revision among patients with aspirinexacerbated respiratory disease (AERD) and other type 2–dominant forms of nasal polyps remain unacceptably high, highlighting our need for these complementary therapies.2 We welcome the inclusion of these agents as part of our evidence-based approach toward the treatment of patients with recurrent nasal polyps. Despite this enthusiasm, significant limitations remain that must be addressed to appropriately use both of these therapies to improve patient care. Trials of ATAD have been largely single-center reports without standardized methodology or consistent aspirin dosages, making direct comparison of results difficult. However, although the overall level of evidence supporting use of ATAD after revision endoscopic sinus surgery (ESS) remains strong, with multiple randomized, controlled trials and treatment recommendations supporting its broad utilization,3,4 adoption remains critically low. More than 30% of surveyed allergists decline to offer ATAD as part of their clinical practice.5 This translates into a challenging situation with few providers and an estimated prevalence of aspirin desensitization as low as 7% among AERD patients seeking care in the United States.6 Despite the clear benefits of ATAD, additional work must be done to increase access to this procedure for our many patients with uncontrolled disease. The multidisciplinary care offered by Bosso et al at the University of Pennsylvania is one of the many examples of allergy/otolaryngology partnerships that must be further incorporated throughout both academic and private practice settings.7 Likewise, although type 2 biologics have a large body of evidence in support of their use for treatment of nasal polyps, substantial work remains to define their appropriate use in the clinical setting.8 There are currently 2 major deficiencies in the currently available evidence that