Subclinical aspirin sensitivity in subjects with nasal polyposis

Evaluation of aspirin hypersensitivity in patients with chronic rhinosinusitis

Conclusion The recurrence rates of chronic rhinosinusitis (CRS) were higher in the aspirin nasal provocation test (ANPT)-positive group, regardless of the presence of nasal polyps. Thus, a careful endoscopic examination is required during follow-up in ANPT-positive patients with CRS. Objectives The aim of this study was to evaluate the clinical features and prognosis after surgical treatment in patients with CRS and aspirin hypersensitivity. Methods In a prospective study, 100 patients were analyzed with CRS who underwent endoscopic sinus surgery at the hospital from October 2012 to March 2013. This study measured changes in nasal volume and symptoms before and after the ANPT and examined patient's asthma history, allergy, Lund-Mackay score (LMS), total immunoglobulin E, percentage of peripheral eosinophils, and objectively measured relapse at 6 months. Results Patients wwith CRS and nasal polyps (CRSwNP) were more likely to have a positive ANPT test result compared to those without nasal polyps (CRSsNP) (21.4% vs 5.5%). The ANPT-positive group had a higher LMS and required more revision endoscopic sinus surgery than those in the ANPT-negative group. The results were that similar results were observed in CRSwNP and CRSsNP.

The prevalence of aspirin hypersensitivity in patients with nasal polyposis and contributing factors

BACKGROUND

Aspirin (acetylsalicylic acid [ASA]) hypersensitivity is frequent in patients with nasal polyps (NPs) and is called aspirin exacerbated respiratory disease, previously known as Samter's syndrome. However, studies evaluating the prevalence of ASA hypersensitivity in patients with NPs using the oral aspirin provocation test (APT) are quite limited. This study was designed to determine the prevalence of ASA hypersensitivity and factors associated with ASA hypersensitivity in patients with NPs.

METHODS

Sixty-eight patients with NPs with or without asthma were recruited. Extension of NPs was evaluated by endoscopic examination/paranasal CT. A 2-day, single-blind placebo-controlled APT was used to detect ASA hypersensitivity.

RESULTS

APT was performed in 53 (21 women/ 32 men) patients (mean age, 39.34 ± 1.76 years). APT resulted positive in 12 patients (22.6%) of whom 3 (25%) had no history of ASA hypersensitivity. Of the positive APTs, three were isolated rhinitis and nine had classic responses. APT was negative in 41 patients (77.4%) although three (7.3%) had a history of ASA hypersensitivity. History of ASA hypersensitivity and prolonged duration of NPs were associated with positive APT (p < 0.05). Advanced NP with multiple operations was also correlated with APT positivity but was not statistically significant. Presence of asthma was associated with age, female gender, NP duration, and ASA hypersensitivity history (p < 0.05), but not with smoking, atopy, NP extension, and positive APT.

CONCLUSION

ASA hypersensitivity is quite common in patients with NP. Patients with extensive and long-term NP with multiple polyp operations require evaluation for the presence of ASA hypersensitivity in terms of chronic management and future risks of the disease.