Aspirin exacerbated respiratory disease: Current topics and trends

Abstract

Aspirin-exacerbated respiratory disease is a chronic and treatment-resistant disease, characterized by the presence of eosinophilic rhinosinusitis, nasal polyposis, bronchial asthma, and nonsteroidal anti-inflammatory drugs hypersensitivity. Alterations in arachidonic acid metabolism may induce an imbalance between pro-inflammatory and anti-inflammatory substances, expressed as an overproduction of cysteinyl leukotrienes and an underproduction of prostaglandin E2. Although eosinophils play a key role, recent studies have shown the importance of other cells and molecules in the development of the disease like mast cells, basophils, lymphocytes, platelets, neutrophils, macrophages, epithelial respiratory cells, IL-33 and thymic stromal lymphopoietin, making each of them promissory diagnostic and treatment targets. In this review, we summarize the most important clinical aspects of the disease, including the current topics about diagnosis and treatment, like provocation challenges and aspirin desensitization. We also discuss recent findings in the pathogenesis of the disease, as well as future trends in diagnosis and treatment, including monoclonal antibodies and a low salicylate diet as a treatment option.

Treatment practices for aspirin‐exacerbated respiratory disease: analysis of a national insurance claims database

“…Therefore, patients are able to safely undergo surgery after AsaD if needed, resume their aspirin doses following surgery, and avoid the need for a formal repeat desensitization. This benefit, along with the advantages of AsaD identified in the present study and many others, argue in favor of AsaD as the standard of care in appropriate AERD patients. Yet this treatment option remains relatively poorly accessible even in the United States.…”

The Effect of Antileukotrienes on the Results of Postoperative Treatment of Paranasal Sinuses in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease

“…Despite the significant importance of disturbances in the metabolism of arachidonic acid leading to the overproduction of proinflammatory CysLTs, drugs blocking receptor or leukotriene C4 synthase (LTC4S) are not recommended [1]. This is in contradiction with reports from the literature [3, 6, 8, 12, 16]. The last update of the ARIA document (Allergic Rhinitis and its Impact on Asthma) from 2016 allows to use antileukotrienes (LTRAs) as a supplement to therapy, especially in patients with asthma, in the case of seasonal allergic rhinitis [22].…”

“…The increased production of prostaglandins D 2 activates eosinophils, basophils, and T helper cells. There are studies on the identification of single nucleotide polymorphisms associated with the inflammatory process in patients with hypersensitivity to NSAIDs and the impact of environmental factors on the disease development [11, 12]. Aspirin-exacerbated respiratory disease is “a complex syndrome typified by underlying airway inflammation in which patients experience adult-onset asthma, nasal polyposis/chronic rhinosinusitis, and aspirin/nonsteroidal anti-inflammatory drug (NSAID) sensitivity” [13].…”

“…Despite the significant importance of disturbances in the metabolism of arachidonic acid leading to the overproduction of proinflammatory CysLTs, drugs blocking receptor or leukotriene C4 synthase (LTC4S) are not recommended [1]. This is in contradiction with reports from the literature [6, 8, 12]. …”

Longitudinal progression of aspirin‐exacerbated respiratory disease: analysis of a national insurance claims database

“…Aspirin‐exacerbated respiratory disease (AERD) is defined as the coexistence of 3 diagnoses: asthma, nasal polyposis, and sensitivity to cyclooxygenase (COX‐1) inhibitors. The disease is more common in women and is thought to affect between 0.6% and 2.5% of the general population and 7% of asthmatic patients . The pathophysiology of the disease is thought to be an enhanced response to COX‐1 inhibition.…”