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Suikkila A, Lyly A, Hafrén L, Saarinen R, Klockars T. Inheritance of NSAID-Exacerbated Respiratory Disease. Otolaryngol Head Neck Surg 2023; 168:540-543. [PMID: 35639475 DOI: 10.1177/01945998221102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/22/2022] [Indexed: 11/17/2022]
Abstract
Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) has been considered an acquired condition. Positive first-degree family history has been reported in 1% of cases. The geographic and genetic isolation of the Finnish population offers exceptional opportunities for inheritance studies. In this questionnaire study, we explored the familial aggregation of N-ERD in 66 Finnish families of patients with N-ERD. The majority of patients (67%) had a positive family history of NSAID intolerance, asthma, nasal polyposis, or N-ERD. Furthermore, 55% had a positive first-degree family history of asthma, 21% nasal polyposis, 20% NSAID intolerance, and 11% N-ERD. The prevalence of asthma, nasal polyposis, NSAID intolerance, and N-ERD among first-degree relatives was 13%, 5%, 4%, and 2%, respectively. We present the pedigrees of the 44 affected families. According to our findings, Finnish patients with N-ERD seem to have a genetic susceptibility to it.
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Affiliation(s)
- Anna Suikkila
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annina Lyly
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lena Hafrén
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riitta Saarinen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Klockars
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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2
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Cockcroft DW. NSAID-exacerbated respiratory disease, dupilumab and aspirin tolerance. Eur Respir J 2023; 61:61/3/2202467. [PMID: 36927861 DOI: 10.1183/13993003.02467-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/27/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Donald W Cockcroft
- Respiratory Medicine, Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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3
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Mehta MP, Wise SK. Unified Airway Disease. Otolaryngol Clin North Am 2023; 56:65-81. [DOI: 10.1016/j.otc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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4
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Ahmad JG, Marino MJ, Luong AU. Unified Airway Disease. Otolaryngol Clin North Am 2023; 56:181-195. [DOI: 10.1016/j.otc.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Lazareva AM, Kolenchukova OA, Smirnova SV. [Theories of the pathogenesis of polypous rhinosinusitis and the asthmatic triad]. Vestn Otorinolaringol 2023; 88:73-80. [PMID: 38153897 DOI: 10.17116/otorino20238806173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Polypous rhinosinusitis (PRS) is a chronic inflammatory disease of the mucous membrane of the nasal cavity and paranasal sinuses, characterized by the formation and recurrent growth of polyps. Often, PRS is a manifestation of the most severe clinical symptom complex - the asthmatic triad (AT). AT is characterized by three main clinical manifestations: bronchial asthma (BA) itself, PRS, intolerance to acetylsalicylic acid, other nonsteroidal anti-inflammatory drugs (NSAIDs) and NA. However, not all three components of the triad are expressed equally, a variant of the dyad (BA with PRS) is possible. AT is one of the most severe variants of BA, it is more difficult to respond to conservative therapy and significantly reduces the ability of patients to work. In the world, PRS and AT are detected in 0.5-16% of the population, in Russia the number of patients is about 1.5 million people. MATERIAL AND METHODS The analysis of the medical literature on this problem has been carried out. RESULTS To date, there is no consensus on the etiology and pathogenesis of the polypous process in the nasal cavity and paranasal sinuses, therefore, many theories of the occurrence of this disease have been proposed, the main ones being: anatomical factors, osteitis, virological, bacterial, allergic, autoimmune theory and the theory of metabolic disorders of arachidonic acid. The key role in modern studies of the pathogenesis of AT is still given to the peculiarities of arachidonic acid metabolism. CONCLUSIONS The low effectiveness of treatment and the severity of clinical manifestations encourage scientists to further investigate the etiopathogenesis of polypous rhinosinusitis and the asthmatic triad.
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Affiliation(s)
- A M Lazareva
- Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | - O A Kolenchukova
- Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | - S V Smirnova
- Krasnoyarsk Scientific Center of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
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6
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Lee JU, Kim MK, Park SL, Bae DJ, Chang HS, Park CS, Park JS. Association of ATP8B3 gene polymorphisms with aspirin-exacerbated respiratory disease in asthmatics. Pharmacogenet Genomics 2022; 32:281-287. [PMID: 35997042 DOI: 10.1097/fpc.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD), an asthma phenotype, often presents with severe manifestations and it remains widely underdiagnosed because of insufficient awareness of the relationship between the ingestion of nonsteroidal anti-inflammatory drugs, including acetylsalicylic acid (ASA), and asthma exacerbation. Our previous genome-wide association study demonstrated an association between a single nucleotide polymorphism (SNP) of the ATP8B3 gene and the risk of AERD. This study examined AERD-related SNPs of the ATP8B3 gene in a large population. METHODS Twenty-five SNPs of ATP8B3 were genotyped with the GoldenGate assay using VeraCode microbeads in 141 asthmatics with AERD and 995 Aspirin-tolerant asthma (ATA). The genotype distribution was analyzed using logistic regression models. The declines in forced expiratory volume in 1 second (FEV1)following an ASA challenge were compared among the genotypes and haplotypes using a type III generalized linear model. RESULTS The minor allele frequencies (MAFs) of rs10421558 A>G in the 5'UTR and rs10403288 G>A in the intron were significantly lower in the AERD than the ATA [34.0% vs. 43.8%, OR = 0.66 (0.62-0.92), Pcorr = 0.03 and 28.4% vs. 35.4%, OR = 0.62 (0.59-0.89), Pcorr = 0.016, respectively]. BL1ht5 was significantly higher in the AERD [7.6% vs. 1.6%, OR = 12.23 (0.2-0.51), P = 4.7 × 10 -4 , Pcorr = 0.001]. Among them, rs10421558 A>G and BL1ht5 were associated with the percent decline in FEV1 on the oral ASA challenge test. CONCLUSION The minor allele of rs10421558 A>G in the 5'UTR may protect against the development of AERD via the increased production of ATP8B3.
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Affiliation(s)
- Jong-Uk Lee
- Department of Medical Bioscience, Graduate School, Soonchunhyang University, Asan
| | - Min Kyung Kim
- Department of Medical Bioscience, Graduate School, Soonchunhyang University, Asan
| | - Seung-Lee Park
- Department of Medical Bioscience, Graduate School, Soonchunhyang University, Asan
| | - Da Jeong Bae
- Department of Medical Bioscience, Graduate School, Soonchunhyang University, Asan
| | - Hun Soo Chang
- Department of Anatomy and BK21 FOUR Project, College of Medicine, Soonchunhyang University, Cheonan
| | - Choon-Sik Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital
- PulmoBioPark Co., Ltd. Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jong Sook Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital
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Suikkila A, Hafrén L, Lyly A, Klockars T, Saarinen R. Patient-Reported Control of Asthma, Nasal Polyposis, and Middle-Ear Symptoms in NSAID-Exacerbated Respiratory Disease. FRONTIERS IN ALLERGY 2022; 2:716169. [PMID: 35386973 PMCID: PMC8974741 DOI: 10.3389/falgy.2021.716169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/21/2021] [Indexed: 01/04/2023] Open
Abstract
Non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is an adult-onset inflammatory condition of the upper and lower airways. It is characterized by the co-existence of asthma, nasal polyposis, and hypersensitivity to NSAIDs. Over one-fourth of patients also have symptoms of chronic middle-ear infection. The clinical course of NERD is often severe and generally requires multimodal treatment with recurrent surgical measures. Studies presenting the disease burden and subjective symptom control of NERD are limited. In this qualitative questionnaire study, we present the clinical characteristics of asthma, nasal polyposis, NSAID intolerance and possible recurrent or chronic middle-ear infection of 66 confirmed NERD patients treated at our tertiary referral center between January 2016 and May 2017. Additionally, we present the patient-reported disease control of asthma, nasal polyposis, and middle-ear symptoms on a four-category Likert scale. The proportion of NERD patients with recurrent or chronic middle-ear infection was 18%. The proportion of good or very good subjective disease control was 83% for asthma, 58% for nasal polyposis, and 33% for chronic middle-ear infection, if present. Chronic middle-ear infection is common among NERD patients and should more often be recognized as part of the entity. Together with nasal polyposis, chronic middle-ear infection seems to affect patients more than asthma. The patient's perspective of disease control should be considered when planning the interdisciplinary follow-up and treatment of NERD.
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Affiliation(s)
- Anna Suikkila
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Lena Hafrén
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Annina Lyly
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tuomas Klockars
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Riitta Saarinen
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Corey KB, Cahill KN. Aspirin-Exacerbated Respiratory Disease: A Unique Case of Drug Hypersensitivity. Immunol Allergy Clin North Am 2022; 42:421-432. [DOI: 10.1016/j.iac.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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Lyly A, Laidlaw TM, Lundberg M. Pathomechanisms of AERD—Recent Advances. FRONTIERS IN ALLERGY 2021; 2:734733. [PMID: 35387030 PMCID: PMC8974777 DOI: 10.3389/falgy.2021.734733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/05/2021] [Indexed: 12/13/2022] Open
Abstract
The pathomechanisms behind NSAID-exacerbated respiratory disease are complex and still largely unknown. They are presumed to involve genetic predisposition and environmental triggers that lead to dysregulation of fatty acid and lipid metabolism, altered cellular interactions involving transmetabolism, and continuous and chronic inflammation in the respiratory track. Here, we go through the recent advances on the topic and sum up the current understanding of the background of this illness that broadly effects the patients' lives.
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Affiliation(s)
- Annina Lyly
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Inflammation Center, Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- *Correspondence: Annina Lyly
| | - Tanya M. Laidlaw
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Marie Lundberg
- Department of Otorhinolaryngology – Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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10
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Cammarota S, Conti V, Corbi G, Di Gregorio L, Dolce P, Fogliasecca M, Iannaccone T, Manzo V, Passaro V, Toraldo B, Valente A, Citarella A. Predictors of Opioid Prescribing for Non-Malignant Low Back Pain in an Italian Primary Care Setting. J Clin Med 2021; 10:jcm10163699. [PMID: 34441993 PMCID: PMC8397205 DOI: 10.3390/jcm10163699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
This study explores which patient characteristics could affect the likelihood of starting low back pain (LBP) treatment with opioid analgesics vs. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in an Italian primary care setting. Through the computerized medical records of 65 General Practitioners, non-malignant LBP subjects who received the first pain intensity measurement and an NSAID or opioid prescription, during 2015–2016, were identified. Patients with an opioid prescription 1-year before the first pain intensity measurement were excluded. A multivariable logistic regression model was used to determine predictive factors of opioid prescribing. Results were reported as Odds Ratios (ORs) with a 95% confidence interval (CI), with p < 0.05 indicating statistical significance. A total of 505 individuals with LBP were included: of those, 72.7% received an NSAID prescription and 27.3% an opioid one (64% of subjects started with strong opioid). Compared to patients receiving an NSAID, those with opioid prescriptions were younger, reported the highest pain intensity (moderate pain OR = 2.42; 95% CI 1.48–3.96 and severe pain OR = 2.01; 95% CI 1.04–3.88) and were more likely to have asthma (OR 3.95; 95% CI 1.99–7.84). Despite clinical guidelines, a large proportion of LBP patients started with strong opioid therapy. Asthma, younger age and pain intensity were predictors of opioid prescribing when compared to NSAIDs for LBP treatment.
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Affiliation(s)
- Simona Cammarota
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., 80143 Naples, Italy; (M.F.); (A.C.)
- Correspondence: ; Tel.: +39-333-532-0054
| | - Valeria Conti
- Clinical Pharmacology and Pharmacogenetics Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84084 Salerno, Italy; (V.C.); (T.I.); (V.M.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy;
- Italian Society of Gerontology and Geriatrics (SIGG), 50122 Florence, Italy
| | - Luigi Di Gregorio
- Parmenide Medical Cooperative, 84084 Salerno, Italy; (L.D.G.); (V.P.)
| | - Pasquale Dolce
- Department of Public Health, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Marianna Fogliasecca
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., 80143 Naples, Italy; (M.F.); (A.C.)
| | - Teresa Iannaccone
- Clinical Pharmacology and Pharmacogenetics Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84084 Salerno, Italy; (V.C.); (T.I.); (V.M.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Valentina Manzo
- Clinical Pharmacology and Pharmacogenetics Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84084 Salerno, Italy; (V.C.); (T.I.); (V.M.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Vincenzo Passaro
- Parmenide Medical Cooperative, 84084 Salerno, Italy; (L.D.G.); (V.P.)
| | | | - Alfredo Valente
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Anna Citarella
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., 80143 Naples, Italy; (M.F.); (A.C.)
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Choby G, Low CM, Levy JM, Stokken JK, Pinheiro-Neto C, Bartemes K, Marino M, Han JK, Divekar R, O'Brien EK, Lal D. Urine Leukotriene E4: Implications as a Biomarker in Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2021; 166:224-232. [PMID: 33973823 DOI: 10.1177/01945998211011060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To provide a comprehensive state-of-the-art review of the emerging role of urine leukotriene E4 (uLTE4) as a biomarker in the diagnosis of chronic rhinosinusitis (CRS), aspirin-exacerbated respiratory disease (AERD), and asthma. DATA SOURCES Ovid MEDLINE(R), Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. REVIEW METHODS A state-of-the-art review was performed investigating the role of uLTE4 as a diagnostic biomarker, predictor of disease severity, and potential marker of selected therapeutic efficacy. CONCLUSIONS uLTE4 has been shown to be a reliable and clinically relevant biomarker for CRS, AERD, and asthma. uLTE4 is helpful in ongoing efforts to better endotype patients with CRS and to predict disease severity. IMPLICATIONS FOR PRACTICE Aside from being a diagnostic biomarker, uLTE4 is also able to differentiate aspirin-tolerant patients from patients with AERD and has been associated with objective disease severity in patients with CRS with nasal polyposis. uLTE4 levels have also been shown to predict response to medical therapy, particularly leukotriene-modifying agents.
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Affiliation(s)
- Garret Choby
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher M Low
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua M Levy
- Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Janalee K Stokken
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos Pinheiro-Neto
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathy Bartemes
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Marino
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Joseph K Han
- Department of Otolaryngology-Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Rohit Divekar
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin K O'Brien
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Devyani Lal
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Scottsdale, Arizona, USA
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Sowerby LJ, Patel KB, Schmerk C, Rotenberg BW, Rocha T, Sommer DD. Effect of low salicylate diet on clinical and inflammatory markers in patients with aspirin exacerbated respiratory disease - a randomized crossover trial. J Otolaryngol Head Neck Surg 2021; 50:27. [PMID: 33892819 PMCID: PMC8063291 DOI: 10.1186/s40463-021-00502-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Aspirin-exacerbated respiratory disease (AERD) is characterized by eosinophilic rhinosinusitis, nasal polyposis, and bronchial asthma, along with the onset of respiratory reactions after the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA). In addition to the therapeutic routines and surgical options available, a low dietary intake of food salicylate has been suggested as adjunctive therapy for this condition. This study aimed to assess the influence of a short-term low salicylate diet on inflammatory markers in patients with AERD and whether that would result in symptomatic improvement. Methods Prospective study with randomization to either a high or low salicylate diet for 1 week, followed by cross-over to the other study arm. Participants were asked to record their dietary salicylate for each week of the study. Urinary creatinine, salicylate and leukotriene levels were measured at the time of recruitment, end of week one and end of week two and the SNOT-22 questionnaire was filled out at the same time points. Results A total of seven participants completed the study. There was no statistical difference in the urinary salicylate and leukotriene levels between the two diets; nevertheless, participants on low salicylate diet reported improved SNOT-22 symptoms scores (p = 0.04), mainly in the rhinologic, ear/facial, and sleep dysfunction symptom domains. In addition, these last two domains outcomes were more significant than the minimal clinically important difference. Conclusions A short-term low salicylate diet may not result in biochemical outcomes changes but seems to provide significant symptomatic relief for patients with AERD. Trial registration NCT01778465 (www.clinicaltrials.gov) Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-021-00502-4.
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Affiliation(s)
- Leigh J Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada.
| | - Krupal B Patel
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Crystal Schmerk
- Department of Medicine, Western University, London, ON, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Taciano Rocha
- Department of Otolaryngology - Head & Neck Surgery, Schulich Medicine & Dentistry, Western University, London Health Sciences Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Doron D Sommer
- Division of Otolaryngology - Department of Surgery, McMaster University, Hamilton, ON, Canada
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13
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Oral administration of hydrolysates of cartilage extract in the prevention of osteoarthritis. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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14
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Aspirin exacerbated respiratory disease (AERD): molecular and cellular diagnostic & prognostic approaches. Mol Biol Rep 2021; 48:2703-2711. [PMID: 33625688 DOI: 10.1007/s11033-021-06240-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
Aspirin-exacerbated respiratory disease (AERD) is characterized by immune cells dysfunction. This study aimed to investigate the molecular mechanisms involved in AERD pathogenesis. Relevant literatures were identified by a PubMed search (2005-2019) of english language papers using the terms "Aspirin-exacerbated respiratory disease", "Allergic inflammation", "molecular mechanism" and "mutation". According to the significant role of inflammation in AERD development, ILC-2 is known as the most important cell in disease progression. ILC-2 produces cytokines that induce allergic reactions and also cause lipid mediators production, which activates mast cells and basophils, ultimately. Finally, Monoclonal antibody and Aspirin desensitization in patients can be a useful treatment strategy for prevention and treatment.
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15
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Bergmark RW, Palumbo M, Rahman S, Maurer R, Dominas C, Roditi R, Bhattacharyya N, Maxfield A, Buchheit KM, Laidlaw TM. Aspirin-Exacerbated Respiratory Disease: Association Between Patient-Reported Sinus and Asthma Morbidity. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1604-1611. [PMID: 33307278 DOI: 10.1016/j.jaip.2020.11.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The association between sinonasal and pulmonary symptoms in aspirin-exacerbated respiratory disease is not fully established. OBJECTIVE To characterize sinonasal and asthma symptomatology, and to determine whether reported sinonasal symptoms predict asthma severity. METHODS Prospectively collected data from an aspirin-exacerbated respiratory disease registry cohort were included from 2013 to 2018. Sinonasal symptomatology measured by Sino-Nasal Outcomes Test (SNOT) 22-item total scores was used as the predictor variable, with Asthma Control Test (ACT) scores and percent predicted FEV1 (FEV1% predicted) as primary outcomes. All instances of paired data on the same date were used. ACT score was also evaluated with FEV1% predicted as the outcome. Mixed effects regression was completed. RESULTS From 1065 aspirin-exacerbated respiratory disease registry subjects (mean age, 48.1 ± 12.8 years; 68.0% females, 29.8% males), mean SNOT-22 score was 42.3 ± 24.12 (n = 1307 observations from 869 subjects), mean ACT score was 19.4 ± 5.2 (n = 1511 observations from 931 subjects), and mean FEV1% predicted was 82.8 ± 19.6 (n = 777 observations from 307 subjects). SNOT-22 score significantly predicted ACT scores (P < .0001, 1185 paired observations from 845 subjects) and FEV1% predicted (P = .018, 485 observations from 246 subjects). Any 10-point increase in SNOT-22 score was associated with a 0.87-point decrease in ACT score and a 0.75% decrease in FEV1% predicted. Any 1-point increase in ACT score was associated with a 1.0% increase in FEV1% predicted (P < .0001, 616 observations from 269 subjects). The most severe SNOT-22 symptoms were sense of smell/taste and blockage/congestion of nose. CONCLUSIONS SNOT-22 scores significantly predict ACT scores and FEV1% predicted, and ACT scores significantly predict FEV1% predicted. This study demonstrates an association between patient-reported rhinosinusitis and asthma symptom severity and subjective and objective measures of asthma severity.
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Affiliation(s)
- Regan W Bergmark
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Mass; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Mass; Patient Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Mass; Center for Surgery and Public Health, Harvard Medical School, Boston, Mass.
| | - Marina Palumbo
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Sarah Rahman
- Center for Surgery and Public Health, Harvard Medical School, Boston, Mass; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rie Maurer
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Mass
| | - Christine Dominas
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Rachel Roditi
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Mass; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Mass
| | - Neil Bhattacharyya
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Mass; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Mass
| | - Alice Maxfield
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Mass; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Mass
| | - Kathleen M Buchheit
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Tanya M Laidlaw
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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Dominas C, Gadkaree S, Maxfield AZ, Gray ST, Bergmark RW. Aspirin-exacerbated respiratory disease: A review. Laryngoscope Investig Otolaryngol 2020; 5:360-367. [PMID: 32596477 PMCID: PMC7314471 DOI: 10.1002/lio2.387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Aspirin-exacerbated respiratory disease (AERD) is a chronic respiratory condition characterized by a triad of symptoms: asthma, chronic rhinosinusitis with nasal polyposis, and a respiratory reaction to aspirin and other cyclooxygenase-1 inhibitors, also known as nonsteroidal anti-inflammatory drugs. The objective of this review is to provide otolaryngologists with an overview of the pathophysiology, diagnosis, and treatment of this under-recognized condition. DATA SOURCES AND METHODS Foundational papers on AERD were reviewed, focusing on the clinical otolaryngology and allergy/immunology literature and other high impact journals or trials. RESULTS AERD results from increased production of pro-inflammatory leukotrienes and a decrease in production of anti-inflammatory prostaglandins associated with the dysregulation of multiple enzymes influencing eicosanoid metabolism. Diagnosis hinges on a high index of suspicion, careful history, and confirmatory testing for all three elements. Treatments include endoscopic sinus surgery; topical, inhaled, or oral corticosteroids; aspirin desensitization; leukotriene modifying drugs; and the new class of biologics such as dupilumab. CONCLUSION AERD is an under-recognized disease associated with substantial patient-reported morbidity. We expect rapid progress in the pathophysiological understanding of this disease and available treatments in the coming decades. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Christine Dominas
- Division of Otolaryngology‐Head and Neck SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Shekhar Gadkaree
- Division of Otolaryngology‐Head and Neck SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Otolaryngology‐Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
| | - Alice Z. Maxfield
- Division of Otolaryngology‐Head and Neck SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Otolaryngology‐Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Stacey T. Gray
- Department of Otolaryngology‐Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Otolaryngology‐Head and Neck SurgeryMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
| | - Regan W. Bergmark
- Division of Otolaryngology‐Head and Neck SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Otolaryngology‐Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Center for Surgery and Public HealthBrigham and Women's HospitalBostonMassachusettsUSA
- Patient Reported Outcomes, Value and Experience (PROVE) CenterBrigham and Women's HospitalBostonMassachusettsUSA
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17
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Hahn J, Appel H, Scheithauer MO, Petereit F, Greve J, Lindemann J, Hoffmann TK, Veit JA, Sommer F. Symptom Control of Patients With Chronic Rhinosinusitis With Nasal Polyps Under Maintenance Therapy With Daily Acetylsalicylic Acid. Am J Rhinol Allergy 2020; 34:554-563. [PMID: 32208749 DOI: 10.1177/1945892420912362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Nonsteroidal anti-inflammatory drugs (NSAID)-exacerbated respiratory disease (NERD) is defined by intolerance to cyclooxygenase 1 inhibitors, chronic rhinosinusitis with recurrent nasal polyps, and/or intrinsic bronchial asthma. Long-term administration of acetylsalicylic acid (ASA) after desensitization has been used to mitigate these sequelae, but the optimal dose and balancing symptom relief and side effects remain unsettled. METHODS Retrospective data analysis of 85 patients with NERD receiving maintenance therapy of 300 mg ASA was followed by questionnaires (our own, not validated and the Sino-Nasal Outcome Test-20). We received responses from 55 patients and examined 30 of them clinically. RESULTS Patients with no ASA-associated side effects were 56.4% (56 of 85 patients) of the cohort. In this study, 60% (33 of 55 patients) continued prophylaxis of 300 mg ASA daily for an average of 34.7 months. Elective surgery was the most frequent cause of discontinuation of ASA (21.8%; 12 of 55 patients). Rhinomanometry values were significantly improved with ASA (P < .05; Wilcoxon), but there was no significant reduction in nasal polyposis or improvement in olfaction at the time of follow-up examination. CONCLUSIONS Minor clinical improvements were identified. Side effects were well tolerated by most patients, and no serious sequelae occurred. The indications for long-term ASA therapy in NERD patients remain unsettled.
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Affiliation(s)
- Janina Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Heike Appel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Marc O Scheithauer
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Florian Petereit
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Jörg Lindemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Johannes A Veit
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinik Mannheim, Mannheim, Germany
| | - Fabian Sommer
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
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18
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Lee K, Lee SH, Kim TH. The Biology of Prostaglandins and Their Role as a Target for Allergic Airway Disease Therapy. Int J Mol Sci 2020; 21:ijms21051851. [PMID: 32182661 PMCID: PMC7084947 DOI: 10.3390/ijms21051851] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 12/11/2022] Open
Abstract
Prostaglandins (PGs) are a family of lipid compounds that are derived from arachidonic acid via the cyclooxygenase pathway, and consist of PGD2, PGI2, PGE2, PGF2, and thromboxane B2. PGs signal through G-protein coupled receptors, and individual PGs affect allergic inflammation through different mechanisms according to the receptors with which they are associated. In this review article, we have focused on the metabolism of the cyclooxygenase pathway, and the distinct biological effect of each PG type on various cell types involved in allergic airway diseases, including asthma, allergic rhinitis, nasal polyposis, and aspirin-exacerbated respiratory disease.
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San Nicoló M, Högerle C, Gellrich D, Eder K, Pfrogner E, Gröger M. The time course of nasal cytokine secretion in patients with aspirin-exacerbated respiratory disease (AERD) undergoing aspirin desensitization: preliminary data. Eur Arch Otorhinolaryngol 2019; 277:445-452. [PMID: 31655881 DOI: 10.1007/s00405-019-05704-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Aspirin-exacerbated respiratory disease (AERD) is a severe form of chronic rhinosinusitis with nasal polyps (CRSwNP) accompanied by asthma and an aspirin intolerance. The underlying pathomechanism of AERD still remains unclear, recent data suggest a complex inflammatory imbalance. In the present study, we investigated the cytokine patterns in AERD, CRSwNP and healthy control patients. Furthermore, we describe the change in cytokine level in the course of aspirin desensitization (AD) with continuous intake of aspirin. METHODS The study included a total of 104 participants, 48 healthy controls, 45 patients with nasal polyps and 11 patients with AERD undergoing AD. Nasal secretions were analyzed for IL-1β, IL-4, IL-5, IL-10, IL-12, IL-13, IL-17, THF-α, IFN-γ, eotaxin and ECP using Bio-Plex Human Cytokine Assay and Uni-CAP FEIA. Baseline measurements of cytokine levels were performed in all 104 patients; in patients with AERD, follow-up was performed 1-6 and 6-24 months after the initiation of AD. RESULTS Our preliminary results show a TH2 dominated, eosinophilic milieu in AERD patients, which decreased in the first weeks of AD. However, after 6 months of AD, proinflammatory cytokines show a tendency to increase again. Also, TH1 as well as Treg associated cytokine seem to increase over time. CONCLUSIONS For the first time, the present work shows the cytokine pattern in nasal secretions of AERD patients before and during AD. Further investigation of the complex interaction of inflammatory cytokines during AD might reveal important insights into the disease entity of AERD and open up new horizons for a targeted therapy.
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Affiliation(s)
- Marion San Nicoló
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Catalina Högerle
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Donata Gellrich
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Katharina Eder
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Elisabeth Pfrogner
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Moritz Gröger
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
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