Published online: December 20, 2018
Aspirin-exacerbated respiratory disease (AERD) is a subset of asthma characterized by the triad of nasal polyposis, asthma, and respiratory reactions to cyclooxygenase 1 (COX-1)–inhibiting medications. Patients with AERD react to aspirin and other non-steroidal-anti-inflammatory drugs (NSAIDs) with characteristic upper and lower respiratory symptoms similar to allergic reactions: nasal congestion, itchy, watery eyes, cough, wheezing, and, sometimes, nausea, vomiting, and skin rash. The appearance of these symptoms in response to aspirin is used during aspirin challenges to diagnose or confirm AERD.
In a recent issue of The Journal of Allergy and Clinical Immunology: In Practice, E. Jerschow et al. report AERD patients’ responses to aspirin challenge at baseline and three to four weeks after sinus surgery. They analyzed clinical responses to aspirin as well as changes in eosinophils and eicosanoids in plasma and urine.
They observed that sinus surgery lessens aspirin reactivity during graded challenges ranging from a decrease in intensity of bronchospasm and fewer upper respiratory symptoms to a complete absence of all clinical symptoms. The loss of aspirin sensitivity was associated with characteristic changes in urine and blood biomarkers. After sinus surgery, AERD patients who did not react to aspirin during the challenge had lower baseline eosinophil counts in the blood and lower prostaglandin D2 to prostaglandin E2 (PGD2/PGE2) ratio in plasma, compared to those who reacted. They also exhibited a lower increase in urine leukotriene E4 (LTE4) levels after aspirin challenge,
The authors concluded that the reduction of nasal polyp burden significantly reduces aspirin sensitivity in AERD patients so that aspirin challenges after sinus surgery are more likely to be asymptomatic. According to this study, diagnostic aspirin challenges should be offered to patients with suspected AERD prior to endoscopic sinus surgery to increase diagnostic accuracy. Furthermore, patients with established AERD should undergo aspirin desensitization after sinus surgery to minimize patient discomfort.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.