Clinical and pathologic perspectives on aspirin sensitivity and asthma - 16/08/11

Doi : 10.1016/j.jaci.2006.07.024

Donald D. Stevenson, MD ^a,^⁎ , Andrew Szczeklik, MD ^b
^a From the Division of Allergy, Asthma and Immunology and the Department of Medicine, Scripps Clinic and the Scripps Research Institute, La Jolla
^b Department of Medicine, Jagellonian University School of Medicine, Krakow

Reprint requests: Donald D. Stevenson, MD, Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla, CA 92037.

La Jolla, Calif, and Krakow, PolandThis activity is available for CME credit. See page 38A for important information.

Abstract

Aspirin and other nonsteroidal anti-inflammatory drugs that inhibit COX-1 induce unique nonallergic reactions, consisting of attacks of rhinitis and asthma. These hypersensitivity reactions occur in a subset of asthmatic subjects, thus identifying them as having this exclusive clinical presentation. We refer to these patients as having aspirin-exacerbated respiratory disease, a disease process that produces devastating eosinophilic inflammation of both the upper and lower respiratory tracts. This review focuses on a description of patients with aspirin-exacerbated respiratory disease, methods available to diagnose their condition, the unique ability of all nonsteroidal anti-inflammatory drugs that inhibit COX-1 to cross-react with aspirin, an update on pathogenesis, and current thoughts about treatment.

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Key words : Aspirin, nonsteroidal anti-inflammatory drugs, asthma, nasal polyps, chronic hyperplastic eosinophilic sinusitis, aspirin-exacerbated respiratory disease, aspirin desensitization

Abbreviations used : AERD, CHES, cysLT₁RA, EP, FLAP, HETE, 5-LO, 5-LOINH, LT, LTC₄S, NSAID, PG, SNP, uLTE₄

Plan

Prevalence

Natural history and clinical presentation of AERD

Respiratory reactions to aspirin and NSAIDs

Cross-reactions among the NSAIDs that inhibit COX-1

Partial cross-reactivity with poor inhibitors of COX-1

Partial cross-reactivity with partially selective COX-2 inhibitors

Unusual cross-reactivity with selective COX-2 inhibitors

Diagnosis of AERD

Pathogenesis

Underlying respiratory disease ()

Aspirin- and NSAID-induced hypersensitivity reactions ()

Aspirin desensitization ()

Treatment

Avoidance of aspirin and NSAIDs and treatment of reactions

Treatment of the underlying respiratory tract disease

Aspirin desensitization

Conclusion

	(Supported by an unrestricted educational grant from Genentech, Inc. and Novartis Pharmaceuticals Corporation) Series editor: Harold S. Nelson, MD
	Disclosure of potential conflict of interest: D. D. Stevenson has received the Skaggs Scholarship Institutional Grant and study grants from Merck and Novartis, is employed by the Scripps Clinic and The Scripps Research Institute, and is on the speakers’ bureau for Merck and Critical Therapeutics. A. Szczeklik declares that he has no conflict of interest.