SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

11/20/05

Tacrolimus treatment does not prevent aspirin-triggered respiratory reactions

Summary
Background – Oral aspirin (ASA) challenge triggers respiratory reactions in individuals with aspirin-exacerbated respiratory disease (AERD), frequently manifest by chronic nasal congestion, nasal polyposis, associated sinus disease and asthma. A recent report described complete prevention of ASA challenge triggered respiratory reactions in patients with AERD by pre-treatment with systemic tacrolimus (Tac) treatment. Tac is a calcineurin inhibitor with immunosuppressive effects.

Findings - Stevenson et al of the Scripps Clinic in La Jolla , Caevaluated pretreatment with Tac, 0.1 mg/kg or placebo before ASA challenge in 10 AERD patients with currently documented asthmatic reactions to ASA challenge. They found that Tac pre-treatment did not prevent ASA challenge triggered respiratory reactions at all in 5 of 8 patients and did not block reactions induced by higher ASA doses in the other 3 patients.

Reference
J. Allergy Clin Immunol 2005;116:755-760

Editor's Comments
The lack of prevention of ASA-induced reactions by Tac pre-treatment reported here by experts in AERD is certainly disappointing. Currently, ASA desensitization has been somewhat tricky, requiring close observation by experienced physicians in a facility equipped for emergency treatment of severe adverse reactions. It would have been a major advance in this area if short term Tac pre-treatment allowed progressively larger doses of ASA to be given in an ASA desensitization protocol without concerns about an adverse reaction occurring.

 

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