Audit of nasal lysine aspirin therapy in recalcitrant aspirin exacerbated respiratory disease

Abstract

BackgroundAspirin – exacerbated respiratory disease can prove difficult to control. Oral aspirin desensitization is effective, but has adverse effects and may not be cardio-protective at the high doses needed.ObjectiveTo examine the effectiveness of aspirin administered in lower doses via the nose.MethodsAn audit of 121 patients with aspirin exacerbated respiratory disease (AERD), 105 of whom were treated with intranasal lysine aspirin in gradually increasing doses following positive lysine aspirin challenge.ResultsTreatment was associated with subjective symptomatic improvement or stabilization in 60 of 78 patients at 3 months and 19 of 27 at 12 months. Nasal inspiratory peak flow, olfaction, exhaled and nasal nitric oxide levels were significantly improved (p < 0.05 for all). Patients with positive skin prick tests and those with later onset (>40 years) AERD improved more than non-atopics and those with early onset AERD.Asthma outcomes over 1 year were assessed by questionnaire in 22 patients on lysine aspirin and in 20 who were positive on challenge but who either refused treatment or took it only briefly (less than or equal to 3 months). There was a significant decrease in emergency visits (p = 0.0182), hospitalization (p = 0.0074) and oral steroid use (p = 0.004) in those on nasal lysine aspirin for a year.Gastrointestinal side effects occurred in 3.8%, lower than those reported for oral aspirin therapy. Conclusions and Clinical Relevance This form of therapy might reduce the need for expensive monoclonal antibodies in AERD patients.

BSACI guideline for the diagnosis and management of allergic and non‐allergic rhinitis (Revised Edition 2017; First edition 2007)

“…[294][295][296][297] A suggestion for NAR therapy is given in Figure 5. [294][295][296][297] A suggestion for NAR therapy is given in Figure 5.…”

“…This may be effective in those with aspirin-sensitive NAR, but should be preceded by nasal or oral aspirin challenge to establish the diagnosis. [294][295][296][297] A suggestion for NAR therapy is given in Figure 5.…”

“…If these fail a nasal aspirin challenge could be undertaken, followed by desensitization if positive. 295,296 Non-inflammatory NAR may respond to anti-cholinergic therapy or to capsaicin. Some patients require both anti-inflammatory and anti-neurogenic treatments.…”

Chronic Rhinosinusitis—Could Phenotyping or Endotyping Aid Therapy?

“…86 Topical nasal desensitization is also effective, uses lower doses of aspirin conjugated with the amino acid lysine to render it soluble, and is less likely to cause side effects such as gastrointestinal bleeding. 87 Not all N-ERD patients respond, those with positive skin prick tests and a longer history appear more likely to benefit. 87…”

Grand Challenges in Rhinology

“…Rhinitis is associated with more asthma-related GP visits and hospital referrals, with associated higher costs, probably because it impairs asthma control to a similar degree as does smoking (49)(50)(51). Effective AR and CRS treatment, both medical and surgical, can improve asthma control (52)(53)(54)(55). Prevention of allergic asthma development by allergen immunotherapy to AR sufferers has been shown with both SCIT and SLIT (31,32), but not yet absolutely proven and the endotype for success with such therapy remains obscure.…”