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Celik GE, Karakaya G, Erkekol FO, Dursun AB, Gelincik A, Aydin O, Damadoglu E, Yucel T, Yorulmaz I, Dursun E, Buyukatalay ZC, Sozener ZC, Buyukozturk S, Kalyoncu AF. Comparison of 300 mg versus 600 mg daily maintenance doses of aspirin treatment after desensitization in N-ERD: A three-year multicentre experience. Allergy Asthma Proc 2023; 44:106-114. [PMID: 36872443 DOI: 10.2500/aap.2023.44.220103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Background: Aspirin treatment after desensitization (ATAD) is effective in preventing nasal polyps recurrence as well as respiratory symptoms in patients with nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory diseases (N-ERD). However, there is no consensus on effective daily maintenance doses in ATAD. Therefore, we aimed to compare the effects of two different maintenance doses of aspirin on clinical outcomes for 1-3 years of ATAD. Methods: This was a retrospective, multicenter study that involved four tertiary centers. The maintenance doses of daily aspirin were 300 mg in one center and 600 mg in the remaining three. The data of patients who were on ATAD for 1-3 years were included. Study outcomes (nasal surgeries, sinusitis, asthma attacks, hospitalization, oral corticosteroid use, and medication uses) were assessed in a standardized way and recorded from case files. Results: The study initially included 125 subjects, 38 and 87 were receiving 300 and 600 mg daily aspirin for ATAD, respectively. Number of nasal polyp surgeries decreased after 1 -3 years compared with before ATAD in both groups (group 1, baseline: 0.44 ± 0.07 versus first year: 0.08 ± 0.05; p < 0.001 and baseline: 0.44 ± 0.07 versus 3rd year: 0.01 ± 0.01; p < 0.001; and group 2, baseline 0.42 ± 0.03 versus first year: 0.02 ± 0.02; p < 0.001 and baseline: 0.42 ± 0.03 versus 3rd year: 0.07 ± 0.03; p < 0.001). Conclusion: Given the comparable effects of 300 mg and 600 mg aspirin daily as maintenance treatment of ATAD on both asthma and sinonasal outcomes in N-ERD, our results suggest using 300 mg of aspirin daily in ATAD owing to its better safety profile.
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Affiliation(s)
- Gulfem Elif Celik
- From the Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Gul Karakaya
- Division of Immunology and Allergy, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ferda Oner Erkekol
- Department of Immunology and Allergy, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Adile Berna Dursun
- Division of Immunology and Allergy, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Asli Gelincik
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Omur Aydin
- From the Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Ebru Damadoglu
- Division of Immunology and Allergy, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Taskin Yucel
- Department of Ear Nose and Throat, Hacettepe University School of Medicine, Ankara, Turkey
| | - Irfan Yorulmaz
- Department of Ear Nose and Throat, Ankara University School of Medicine, Ankara, Turkey, and
| | - Engin Dursun
- Department of Ear Nose and Throat, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | | | - Zeynep Celebi Sozener
- From the Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Suna Buyukozturk
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Fuat Kalyoncu
- Division of Immunology and Allergy, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey
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Çelik GE, Aydin Ö, Güloğlu D, Seçil D, Melli M, Doğu F, Ikinciogullari A, Sin BA, Demirel Y, Misirligil Z. What happens to basophils and tryptase, LXA 4 and CysLTs during aspirin desensitization? J Asthma 2022:1-11. [PMID: 36472920 DOI: 10.1080/02770903.2022.2156352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Aspirin desensitization (AD) is an effective treatment in patients with non-steroidal anti-inflammatory drugs (NSAID)-exacerbated respiratory disease (NERD) by providing inhibitory effect on symptoms and polyp recurrence. However, limited data is available on how AD works. We aimed to study comprehensively the mechanisms underlying AD by examining basophil activation (CD203c upregulation), mediator-releases of tryptase, CysLT, and LXA4, and LTB4 receptor expression for the first 3 months of AD. METHODS The study was conducted in patients with NERD who underwent AD (group 1: n = 23), patients with NERD who received no desensitization (group 2: n = 22), and healthy volunteers (group 3, n = 13). All participants provided blood samples for flow cytometry studies (CD203c and LTB4 receptor), and mediator releases (CysLT, LXA4, and tryptase) for the relevant time points determined. RESULTS All baseline parameters of CD203c and LTB4 receptor expressions, tryptase, CysLT, and LXA4 releases were similar in each group (p > 0.05). In group 1, CD203c started to be upregulated at the time of reactions during AD, and continued to be high for 3 months when compared to controls. All other study parameters were comparable with baseline and at the other time points in each group (p > 0.05). CONCLUSION Although basophils are active during the first 3 months of AD, no releases of CysLT, tryptase or LXA4 exist. Therefore, our results suggest that despite active basophils, inhibition of mediators can at least partly explain underlying the mechanism in the first three months of AD.
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Affiliation(s)
- Gülfem E Çelik
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Ömür Aydin
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Deniz Güloğlu
- Division of Pediatric Allergy and Immunology, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Derya Seçil
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Mehmet Melli
- Department of Medical Pharmacology, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Figen Doğu
- Division of Pediatric Allergy and Immunology, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Aydan Ikinciogullari
- Division of Pediatric Allergy and Immunology, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Betül A Sin
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Yavuz Demirel
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Zeynep Misirligil
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
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Aydin Ö, Atmiş EÖ, Anadolu Y, Yorulmaz İ, Çelİk GE. Aspirin desensitization following endoscopic sinus surgery is effective in patients with nonsteroidal antiinflammatory drug exacerbated respiratory disease. J Asthma 2022; 60:1131-1140. [PMID: 36218308 DOI: 10.1080/02770903.2022.2134793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Introduction: Aspirin desensitization (AD) is effective in relieving asthma and sinonasal outcomes in patients with non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD). So far, only a limited number of studies evaluated the effect of AD prospectively in a controlled manner in N-ERD. It is also a current approach to recommend endoscopic sinus surgery (ESS) before AD. This study aimed to prospectively document the clinical effects of AD for 1 year in patients with N-ERD who underwent ESS in the presence of a control group.Methods: The study included patients with N-ERD who underwent AD (group 1, n = 22) and patients with N-ERD in whom desensitization was indicated but was not performed (group 2, n = 21). All patients had ESS before enrolment in the study. Asthma and rhinosinusitis outcomes were assessed at baseline and after 1 year.Results: The study included a total of 43 subjects (F/M:28/15, mean age: 44.7 ± 2.8 years). Fewer patients had nasal polyp recurrency in group 1 (5/22, 22.7%) than in group 2 (11/21, 52.3%) at the end of the first year (p = 0.035). Smell-test scores were preserved only in group 1 after 1 year. There were significant decreases in the use of both asthma and nasal medications only in group 1.Conclusion: Our results strongly support the use of AD for the improvement of both nasal and asthmatic outcomes in patients with N-ERD for 1 year. We also recommend patients undergo ESS before AD. Further controlled studies are necessary to evaluate whether this effect lasts longer.
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Affiliation(s)
- Ömür Aydin
- Ankara University School of Medicine, Department of Chest Disease, Division of Immunology and Allergy
| | - Esin Özlem Atmiş
- Ankara University School of Medicine, Department of Ear Nose and Throat
| | - Yücel Anadolu
- Ankara University School of Medicine, Department of Ear Nose and Throat
| | - İrfan Yorulmaz
- Ankara University School of Medicine, Department of Ear Nose and Throat
| | - Gülfem Elif Çelİk
- Ankara University School of Medicine, Department of Chest Disease, Division of Immunology and Allergy
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van der Lans RJL, Fokkens WJ, Reitsma S. Therapeutic Options for Chronic Rhinosinusitis in N-ERD Patients. FRONTIERS IN ALLERGY 2021; 2:734000. [PMID: 35387032 PMCID: PMC8974668 DOI: 10.3389/falgy.2021.734000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 11/25/2022] Open
Abstract
Patients with non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) often suffer from chronic rhinosinusitis (CRS) with nasal polyps, a form of primary diffuse Type 2 CRS. Although this disease is also seen in NSAID-tolerant patients, CRS in N-ERD often is more severe and more treatment resistant; local nasal therapy (nasal corticosteroids) and endoscopic sinus surgery are employed like in NSAID-tolerant patients, but with limited and/or short-lived effects. This mini-review gives an overview of the current additional treatment options for CRS in N-ERD. As such diets, aspirin therapy after desensitization, antileukotriene therapy and biologicals are discussed based on the current body of literature. Selecting the right treatment strategy depends on shared-decision making, local availability and cooperation between ENT-surgeons, allergists, and pulmonologists.
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Cingi C, Bayar Muluk N, Mitsias DI, Papadopoulos NG, Klimek L, Laulajainen-Hongisto A, Hytönen M, Toppila-Salmi SK, Scadding GK. The Nose as a Route for Therapy: Part 1. Pharmacotherapy. FRONTIERS IN ALLERGY 2021; 2:638136. [PMID: 35387039 PMCID: PMC8974766 DOI: 10.3389/falgy.2021.638136] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/08/2021] [Indexed: 12/30/2022] Open
Abstract
This article reviews nasal structure and function in the light of intranasal pharmacotherapy. The nose provides an accessible, fast route for local treatment of nose and sinus diseases, with lower doses than are necessary systemically and few adverse effects. It can also be used for other medications as it has sufficient surface area protected from local damage by mucociliary clearance, absence of digestive enzymes, responsive blood flow, and provides a rapid route to the central nervous system.
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Affiliation(s)
- Cemal Cingi
- Department of Otolaryngology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Nuray Bayar Muluk
- Department of Otolaryngology, Kirikkale University, Kirikkale, Turkey
| | - Dimitrios I Mitsias
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Ludger Klimek
- Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - Anu Laulajainen-Hongisto
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Sanna Katriina Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.,Faculty of Medicine, The Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Glenis Kathleen Scadding
- University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Royal National Throat Nose and Ear Hospital, London, United Kingdom
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High Discontinuation Rates of Peroral ASA Treatment for CRSwNP: A Real-World Multicenter Study of 171 N-ERD Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3565-3574. [PMID: 32693216 DOI: 10.1016/j.jaip.2020.06.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drug (NSAID) exacerbated respiratory disease (N-ERD) consists of chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and NSAID intolerance. Acetylsalicylic acid treatment after desensitization (ATAD) is a treatment option for uncontrolled N-ERD. OBJECTIVE To evaluate peroral ATAD's long-term effectiveness on CRSwNP disease control. METHODS The retrospective data (patient characteristics, sinus surgeries before ATAD, ATAD, follow-up data [2019]) were collected from patient records of 171 patients with N-ERD (102 ATAD patients, 69 controls with CRSwNP+N-ERD without ATAD) who underwent tertiary hospital consultation from 2001 to 2017. Outcome measurements were ATAD discontinuation, revision sinus surgery, and corticosteroid and antibiotic courses for airway infections during 2016-2019. Associations were analyzed by survival and nonparametric methods. RESULTS The ATAD group had more tissue eosinophilia, symptoms, and sinus surgeries before ATAD than others. The ATAD discontinuation rate was 63%, independent of ATAD dose or duration, usually due to side effects. Compared with the N-ERD group without ATAD, ATAD (mean duration, 2.9 years) did not affect the revision endoscopic sinus surgery rate (P = .21, by the log-rank test) or the number of peroral corticosteroid courses per year (P > .05, by the Mann-Whitney U-test) during the follow-up (mean, 7.6 years) despite the dose or duration of ATAD. CONCLUSIONS The discontinuation rate of ATAD was high (63%), and ATAD did not affect revision sinus surgery rate nor the need of peroral corticosteroids during follow-up. However, the remaining 37% of the ATAD group did continue the treatment, indicating that they may have benefited from ATAD.
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7
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Gan KL, Lourijsen E, Avdeeva K, Fokkens W. Oral and intranasal aspirin desensitisation for non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease. Hippokratia 2019. [DOI: 10.1002/14651858.cd013476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kit Liang Gan
- Academic Medical Centre; Department of Otorhinolaryngology; Amsterdam Netherlands
| | - Evelijn Lourijsen
- Academic Medical Centre; Department of Otorhinolaryngology; Amsterdam Netherlands
| | - Klementina Avdeeva
- Academic Medical Centre; Department of Otorhinolaryngology; Amsterdam Netherlands
| | - Wytske Fokkens
- Academic Medical Centre; Department of Otorhinolaryngology; Amsterdam Netherlands
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Kowalski ML, Agache I, Bavbek S, Bakirtas A, Blanca M, Bochenek G, Bonini M, Heffler E, Klimek L, Laidlaw TM, Mullol J, Niżankowska‐Mogilnicka E, Park H, Sanak M, Sanchez‐Borges M, Sanchez‐Garcia S, Scadding G, Taniguchi M, Torres MJ, White AA, Wardzyńska A. Diagnosis and management of NSAID-Exacerbated Respiratory Disease (N-ERD)-a EAACI position paper. Allergy 2019; 74:28-39. [PMID: 30216468 DOI: 10.1111/all.13599] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 01/04/2023]
Abstract
NSAID-exacerbated respiratory disease (N-ERD) is a chronic eosinophilic, inflammatory disorder of the respiratory tract occurring in patients with asthma and/or chronic rhinosinusitis with nasal polyps (CRSwNP), symptoms of which are exacerbated by NSAIDs, including aspirin. Despite some progress in understanding of the pathophysiology of the syndrome, which affects 1/10 of patients with asthma and rhinosinusitis, it remains a diagnostic and therapeutic challenge. In order to provide evidence-based recommendations for the diagnosis and management of N-ERD, a panel of international experts was called by the EAACI Asthma Section. The document summarizes current knowledge on the pathophysiology and clinical presentation of N-ERD pointing at significant heterogeneity of this syndrome. Critically evaluating the usefulness of diagnostic tools available, the paper offers practical algorithm for the diagnosis of N-ERD. Recommendations for the most effective management of a patient with N-ERD stressing the potential high morbidity and severity of the underlying asthma and rhinosinusitis are discussed and proposed. Newly described sub-phenotypes and emerging sub-endotypes of N-ERD are potentially relevant for new and more specific (eg, biological) treatment modalities. Finally, the document defines major gaps in our knowledge on N-ERD and unmet needs, which should be addressed in the future.
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Affiliation(s)
| | - Ioana Agache
- Medical School Brasov Transylvania University Brasov Romania
| | - Sevim Bavbek
- Division of Allergy and Clinical Immunology Department of Chest Diseases School of Medicine Ankara University Ankara Turkey
| | - Arzu Bakirtas
- Department Pediatric Allergy and Asthma Faculty of Medicine Gazi University Ankara Turkey
| | - Miguel Blanca
- Allergy Service Hospital Infanta Leonor Madrid Spain
| | - Grażyna Bochenek
- Department of Internal Medicine Jagiellonian University Medical College Krakow Poland
| | - Matteo Bonini
- National Heart and Lung Institute Royal Brompton Hospital & Imperial College London London UK
| | - Enrico Heffler
- Department of Biomedical Sciences, Personalized Medicine Asthma and Allergy Clinic Humanitas University Milano Italy
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Tanya M. Laidlaw
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston Massachusetts
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic ENT Department Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy IDIBAPS, and CIBERES Barcelona Spain
| | | | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon Korea
| | - Marek Sanak
- Division of Molecular Biology and Clinical Genetics Department of Internal Medicine Jagiellonian University Medical College Kraków Poland
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Medico‐Docente La Trinidad Caracas Venezuela
| | | | - Glenis Scadding
- Department of Allergy & Rhinology Royal National TNE Hospital London UK
| | - Masami Taniguchi
- Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital Sagamihara Japan
| | - Maria J. Torres
- Allergy Unit Malaga Regional University Hospital‐IBIMA ARADyAL Málaga Spain
| | - Andrew A. White
- Department of Allergy, Asthma and Immunology Scripps Clinic San Diego California
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9
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Management of Respiratory Symptoms Induced by Non-Steroidal Anti-Inflammatory Drugs. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0129-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Plasma 15-Hydroxyeicosatetraenoic Acid Predicts Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:998-1007.e2. [PMID: 28159558 DOI: 10.1016/j.jaip.2016.11.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/01/2016] [Accepted: 11/23/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Aspirin desensitization followed by daily aspirin provides therapeutic benefits to patients with aspirin-exacerbated respiratory disease (AERD). It is not well understood how eicosanoid levels change during aspirin treatment. OBJECTIVE To investigate associations between clinical outcomes of aspirin treatment and plasma eicosanoid levels in patients with AERD. METHODS Thirty-nine patients with AERD were offered aspirin treatment (650 mg twice daily) for 4 weeks. Respiratory parameters and plasma levels of multiple eicosanoids were recorded at baseline and after 4 weeks of aspirin therapy using the Asthma Control Test and Rhinoconjunctivitis Quality of Life Questionnaire. Respiratory function was evaluated using the FEV1 and nasal inspiratory peak flow. RESULTS After aspirin treatment, respiratory symptoms improved in 16 patients, worsened in 12 patients, and did not change in 4 patients. Seven patients were unable to complete the desensitization protocol. Patients with symptom improvement had higher baseline plasma 15-hydroxyeicosatetraenoic acid (15-HETE) levels than did patients with symptom worsening: 7006 pg/mL (interquartile range, 6056-8688 pg/mL) versus 4800 pg/mL (interquartile range, 4238-5575 pg/mL), P = .0005. Baseline 15-HETE plasma levels positively correlated with the change in Asthma Control Test score (r = 0.61; P = .001) and in FEV1 after 4 weeks of aspirin treatment (r = 0.49; P = .01). It inversely correlated with Rhinoconjunctivitis Quality of Life Questionnaire score (r = -0.58; P = .002). Black and Latino patients were more likely to have symptom worsening on aspirin or fail to complete the initial desensitization than white, non-Latino patients (P = .02). CONCLUSIONS In patients with AERD, low baseline 15-HETE plasma levels and black or Latino ethnicity are associated with worsening of respiratory symptoms during aspirin treatment.
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11
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Williams AN. Diagnostic Evaluation in Aspirin-Exacerbated Respiratory Disease. Immunol Allergy Clin North Am 2016; 36:657-668. [PMID: 27712761 DOI: 10.1016/j.iac.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Aspirin-exacerbated respiratory disease (AERD) is a distinct clinical condition characterized by chronic sinusitis with nasal polyps, asthma, and hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). Distinguishing AERD from other forms of chronic sinusitis, asthma, and NSAID reactivity has important clinical implications for management. The clinical history is helpful, but not adequate for confirming the diagnosis of AERD, in most cases. Diagnostic provocation challenge remains the only way to confirm or exclude the diagnosis of AERD. This article discusses the utility of the clinical history and the current evidence regarding measures that optimize the safety of performing diagnostic NSAID provocation challenges.
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Affiliation(s)
- Adam N Williams
- Department of Allergy, Asthma, and Immunology, Bend Memorial Clinic, 815 Southwest Bond Street, Bend, OR 97702, USA; School of Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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12
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Kowalski ML, Wardzyńska A, Makowska JS. Clinical Trials of Aspirin Treatment After Desensitization in Aspirin-Exacerbated Respiratory Disease. Immunol Allergy Clin North Am 2016; 36:705-717. [PMID: 27712765 DOI: 10.1016/j.iac.2016.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The clinical efficacy of aspirin treatment after desensitization in patients with respiratory disease exacerbated by nonsteroidal anti-inflammatory drugs has been documented in observational studies and in double-blind placebo-controlled trials. There is no general agreement with regard to the optimal maintenance dose or duration of treatment with acetylsalicylic acid after desensitization, thus further studies are necessary to offer clear guidelines to clinicians. This article summarizes data from noncontrolled, active-control, and placebo-controlled trials assessing clinical effectiveness and reporting on safety of treatment with acetylsalicylic acid in desensitized patients with respiratory disease exacerbated by nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
- Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Center, Medical University of Łódź, 251 Pomorska Street, Łódź 92-213, Poland.
| | - Aleksandra Wardzyńska
- Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Center, Medical University of Łódź, 251 Pomorska Street, Łódź 92-213, Poland
| | - Joanna S Makowska
- Department of Rheumatology, Medical University of Łódź, 30 Pieniny Street, Łódź 92-115, Poland
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13
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Adaptive Desaktivierung bei Analgetikaintoleranz. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Hulse KE, Stevens WW, Tan BK, Schleimer RP. Pathogenesis of nasal polyposis. Clin Exp Allergy 2015; 45:328-46. [PMID: 25482020 DOI: 10.1111/cea.12472] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex inflammatory condition that affects a large proportion of the population world-wide and is associated with high cost of management and significant morbidity. Yet, there is a lack of population-based epidemiologic studies using current definitions of CRSwNP, and the mechanisms that drive pathogenesis in this disease remain unclear. In this review, we summarize the current evidence for the plethora of factors that likely contribute to CRSwNP pathogenesis. Defects in the innate function of the airway epithelial barrier, including diminished expression of antimicrobial products and loss of barrier integrity, combined with colonization by fungi and bacteria likely play a critical role in the development of chronic inflammation in CRSwNP. This chronic inflammation is characterized by elevated expression of many key inflammatory cytokines and chemokines, including IL-5, thymic stromal lymphopoietin and CCL11, that help to initiate and perpetuate this chronic inflammatory response. Together, these factors likely combine to drive the influx of a variety of immune cells, including eosinophils, mast cells, group 2 innate lymphoid cells and lymphocytes, which participate in the chronic inflammatory response within the nasal polyps. Importantly, however, future studies are needed to demonstrate the necessity and sufficiency of these potential drivers of disease in CRSwNP. In addition to the development of new tools and models to aid mechanistic studies, the field of CRSwNP research also needs the type of robust epidemiologic data that has served the asthma community so well. Given the high prevalence, costs and morbidity, there is a great need for continued research into CRS that could facilitate the development of novel therapeutic strategies to improve treatment for patients who suffer from this disease.
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Affiliation(s)
- K E Hulse
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Giavina-Bianchi P, Aun MV, Galvão VR, Castells M. Rapid Desensitization in Immediate Hypersensitivity Reaction to Drugs. CURRENT TREATMENT OPTIONS IN ALLERGY 2015. [DOI: 10.1007/s40521-015-0060-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Stevens WW, Schleimer RP, Chandra RK, Peters AT. Biology of nasal polyposis. J Allergy Clin Immunol 2014; 133:1503, 1503.e1-4. [PMID: 24766878 DOI: 10.1016/j.jaci.2014.03.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 01/07/2023]
Affiliation(s)
- Whitney W Stevens
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert P Schleimer
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Rakesh K Chandra
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Anju T Peters
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
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17
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Naclerio RM, Pinto J, Baroody F. Evidence-based approach to medical and surgical treatment of nasal polyposis. J Allergy Clin Immunol 2014; 132:1461-1462.e3. [PMID: 24286725 DOI: 10.1016/j.jaci.2013.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/18/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
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