Intranasal lysine-aspirin administration decreases polyp volume in patients with aspirin-intolerant asthma

Abstract

Introduction: Nasal polyposis associated with aspirin-intolerant asthma tends to be difficult to control, with frequent recurrences. We examined the effect of intranasal lysine-aspirin administration on resistant nasal polyps of asthmatic, aspirin-intolerant patients, when used in addition to routine therapy.Patients and methods: Thirteen patients with asthma and intolerance to aspirin were recruited. All but one had undergone numerous polypectomies and were uncontrolled on standard therapy with intranasal corticosteroids, leukotriene receptor antagonists and nasal douching. Aspirin treatment involved one drop (100 ml) of 30 mg/ml lysine-aspirin solution to each nostril, initially daily, increased every two or three days up to a maximal of 18 drops (54 mg lysine-aspirin) a day. Nasal symptoms, nitric oxide level, nasal inspiratory peak flow rate, peak expiratory flow rate and nasendoscopic grading were assessed prior to therapy and three months later. We also compared the change in endoscopic polyp scores during three months of lysine-aspirin administration with the changes which had occurred during the three months prior to administration (during which time other therapies had been identical).Results: Nasal blockage symptoms tended to decrease; other nasal symptoms were unchanged. Significant changes were seen in nasal inspiratory peak flow rate (103.3 + 18.9 and 140.0 + 16.7 l/ min before and after aspirin, respectively; p ¼ 0.014), but not in peak expiratory flow rate (438.7 + 33.4 and 440.0 + 28.4 l/min before and after aspirin, respectively; p ¼ 0.700). Nasal nitric oxide levels rose significantly (in both sides, p ¼ 0.028). Expired chest nitric oxide levels did not change. Nasal polyp scores on nasendoscopic examination were significantly reduced (right side, p ¼ 0.027; left side, p ¼ 0.018). Compared with the preceding three months, adding intranasal lysine-aspirin application had the effect on decreasing nasal polyp volume (right side, p ¼ 0.031; left side, p ¼ 0.016).Conclusion: This open study suggests that intranasal lysine-aspirin administration reduces nasal polyp volume in aspirin-intolerant patients, without any adverse affect on concomitant asthma. This was a preliminary study and should be followed by a placebo-controlled, double-blind trial.

Evidence-Based Management of Nasal Polyposis by Intranasal Corticosteroids: From the Cause to the Clinic

“…antihistamines, intranasal amphotericin B, capsaicin, furosemide, antileukotrienes, lysine aspirin desensitization, and anti-IL-5 and anti-IgE antibodies, mucosal atomization device), but substantial evidence of their benefit in a large number of patients is currently lacking (table 3) [8,105,106,107,108,109,110,111,112,113,114,115]. Among therapies investigated, anti-IL-5 antibodies warrant further study based on promising results from a small (n = 24), randomized, double-blind single-injection study in patients with bilateral nasal polyps.…”

Aspirin desensitisation therapy for aspirin-intolerant chronic rhinosinusitis

“…One author group have reported a lack of efficacy with a regimen of 16 mg of topical L-ASA or placebo instilled intranasally every 48 hours for six months (Parikh 2005). However, the same group reported improvements in polyp scores, peak nasal inspiratory flow rates and nasal nitric oxide levels using an endonasal regimen of 30 mg/ml L-ASA to each side in a dose ramp from 2 mg/day, increased every two or three days up to a maximum of 54 mg/day (Ogata 2007).…”

Current management of aspirin‐exacerbated respiratory disease

“…8,9 Nasal therapy with increasing doses of lysine aspirin following a positive nasal challenge has been used in our department for several years. 10 Most patients can reach a total dose equivalent to 60-75mg aspirin in the nose, with benefit in the majority and a better safety profile than with oral aspirin.…”