Published Online: March, 2014
Sulfasalazine (SSZ) has long been used in the treatment of ulcerative colitis. R. M. Karr at the University of Washington Medical Center, Seattle, reports in The Journal of Allergy and Clinical Immunology: In Practice, a case in which SSZ as a nasosinus rinse led to substantial clinical improvement.
The patient was a young woman with CRS and nasal polyps but without aspirin sensitivity. She had previously undergone a surgical sinus procedure to remove nasal polyps, but the condition recurred and failed to respond to conventional treatment with antibiotics, leukotriene modifiers, and topical corticosteroid nasal sprays.
After four months of using only sulfasalazine nasosinus rinse, symptoms improved as measured by a validated patient questionnaire generated score, exam findings of nasal polyp shrinkage, and sinus computerized tomography (CT) studies demonstrating partial but very significant clearing of maxillary and ethmoid sinuses.
The hypothesized mechanism of action relates to the observation that CRS and ulcerative colitis have been reported to share characteristics of T helper cell 2 (Th2) mediated inflammation. Recognizing the limitations of a single case report, the findings provide a basis for further study to explore the safety and efficacy—as well as optimal dosing and combination use—of SSZ in the treatment of CRS.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.