Sinus surgery improves lower respiratory tract reactivity during aspirin desensitization for AERD

Huang, Guanling; Palumbo, Michelle; Singer, Joseph; Cahill, Katherine N.; Laidlaw, Tanya M.

doi:10.1016/j.jaip.2019.02.037

Cited by 24 publications

(17 citation statements)

References 11 publications

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“…Strikingly, despite having positive reactions preoperatively, 43% of these patients developed no symptoms during the postoperative aspirin desensitization. These findings were validated in a separate retrospective study by Huang et al 71 who reported a decreased risk of significant airway reactions following sinus surgery (odds ratio, 9; P 5 .033).…”

Section: Surgical Managementsupporting

confidence: 61%

“…In addition, the reactions to aspirin are also generally less severe when the desensitization is performed following sinus surgery. 70,71 Although controlled studies are lacking, general expert consensus suggests that longterm clinical outcomes are improved when the initiation of aspirin therapy occurs after sinus surgery. Therefore, whenever possible and appropriate, it is often recommended that a sinus surgery to debulk the inflammatory nasal polyp tissue precede aspirin desensitization.…”

Section: Planned Sinus Surgerymentioning

confidence: 99%

“…97,98 Given the emerging evidence of decreased reaction severity associated with postoperative aspirin desensitization, complete FESS with debulking of inflammatory polyp burden should be considered before desensitization in any surgically naive patient or those with significant polyp burden. 70,71…”

Section: Surgical Managementmentioning

confidence: 99%

“…Although the tests are not traditionally part of routine clinical evaluation, the degree of elevation of baseline LTE 4 and PGD 2 in the urine is known to be associated with the severity of respiratory reactions and the extent to which FEV 1 falls during aspirin-induced reactions. 4,49,117 From a clinical standpoint, duration of challenge, 118 the current state of the sinuses (preoperative vs postoperative), 70,71 and pretreatment with leukotriene modifiers, 66,86 antihistamines, 91 misoprostol, 119 and mast cell stabilizers such as cromolyn sodium 120 and presumably ketotifen can all impact the severity of symptoms observed during a desensitization, and rarely can completely block both upper and lower airway symptoms from developing. If an aspirin challenge performed on 1 of these medications is negative, and the diagnosis of AERD is still unclear, there may be benefit in repeating the procedure off these medications, assuming asthma and rhinitis control remain stable, as discussed below.…”

Section: Factors That May Predict the Severity Of Aspirininduced Reactionsmentioning

confidence: 99%

See 3 more Smart Citations

The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma & Immunology

Stevens

Jerschow

Baptist

et al. 2021

Journal of Allergy and Clinical Immunology

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Section: Surgical Managementsupporting

confidence: 61%

Section: Planned Sinus Surgerymentioning

confidence: 99%

Section: Surgical Managementmentioning

confidence: 99%

Section: Factors That May Predict the Severity Of Aspirininduced Reactionsmentioning

confidence: 99%

See 2 more Smart Citations

The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma & Immunology

Stevens

Jerschow

Baptist

et al. 2021

Journal of Allergy and Clinical Immunology

Self Cite

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“…It was suggested that aspirin challenge/desensitization should be proposed to patients shortly after sinus surgery when their aspirin-induced hypersensitivity reactions become less severe. 14,[37][38][39][40] In our study, 28 patients (82%) underwent sinus surgery, among which 13 patients within the year before aspirin treatment initiation. An additional positive prognostic factor in our study was female sex, as only one woman (4% of females) did not benefit from treatment.…”

Section: Discussionmentioning

confidence: 77%

Biomarkers for predicting response to aspirin therapy in aspirin‐exacerbated respiratory disease

Tyrak

Pajdzik

Jakieła

et al. 2021

Clin Experimental Allergy

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Background Aspirin desensitization followed by daily aspirin use is an effective treatment for aspirin‐exacerbated respiratory disease (AERD). Objective To assess clinical features as well as genetic, immune, cytological and biochemical biomarkers that might predict a positive response to high‐dose aspirin therapy in AERD. Methods We enrolled 34 AERD patients with severe asthma who underwent aspirin desensitization followed by 52‐week aspirin treatment (650 mg/d). At baseline and at 52 weeks, clinical assessment was performed; phenotypes based on induced sputum cells were identified; eicosanoid, cytokine and chemokine levels in induced sputum supernatant were determined; and induced sputum expression of 94 genes was assessed. Responders to high‐dose aspirin were defined as patients with improvement in 5‐item Asthma Control Questionnaire score, 22‐item Sino‐Nasal Outcome Test (SNOT‐22) score and forced expiratory volume in 1 second at 52 weeks. Results There were 28 responders (82%). Positive baseline predictors of response included female sex (p = .002), higher SNOT‐22 score (p = .03), higher blood eosinophil count (p = .01), lower neutrophil percentage in induced sputum (p = .003), higher expression of the hydroxyprostaglandin dehydrogenase gene, HPGD (p = .004) and lower expression of the proteoglycan 2 gene, PRG2 (p = .01). The best prediction model included Asthma Control Test and SNOT‐22 scores, blood eosinophils and total serum immunoglobulin E. Responders showed a marked decrease in sputum eosinophils but no changes in eicosanoid levels. Conclusions and Clinical Relevance Female sex, high blood eosinophil count, low sputum neutrophil percentage, severe nasal symptoms, high HPGD expression and low PRG2 expression may predict a positive response to long‐term high‐dose aspirin therapy in patients with AERD.

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Biomarkers for predicting response to long‐term high dose aspirin therapy in aspirin‐exacerbated respiratory disease

Mastalerz

Tyrak

2021

Clinical & Translational All

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Introduction Aspirin‐exacerbated respiratory disease (AERD) is a phenotype of asthma characterized by eosinophilic inflammation in the airways, mast cell activation, cysteinyl leukotriene overproduction, and acute respiratory reactions on exposure to cyclooxygenase‐1 inhibitors. Aspirin desensitization followed by daily high‐dose aspirin therapy is a safe and effective treatment option for the majority of patients with AERD. However, there is still some percentage of the population who do not derive benefits from daily aspirin use. Methods Based on the current literature, the biomarkers, which might predict aspirin treatment outcomes in AERD patients, were evaluated. Results and conclusions Patients with severe symptoms of chronic rhinosinusitis, type 2 asthma based on blood eosinophilia, non‐neutrophilic inflammatory phenotype based on sputum cells, as well as high plasma level of 15‐hydroxyeicosatetraenoic acid (15‐HETE) are potentially good responders to long term high‐dose aspirin therapy. Additionally, high expression of the hydroxyprostaglandin dehydrogenase gene, HPGD encoding prostaglandin‐degrading enzyme 15‐hydroxyprostaglandin dehydrogenase (15‐PGDH) and low expression of the proteoglycan 2 gene, PRG2 encoding constituent of the eosinophil granule in sputum cells might serve as a predictor of good response to aspirin therapy. Variations in the expression of cysteinyl leukotriene receptor 1 in the airways could additionally influence the response to long‐term aspirin therapy. Arachidonic acid metabolites levels via the 5‐lipoxygenase as well as via the cyclooxygenase pathways in induced sputum supernatant do not change during high dose long‐term aspirin therapy and do not influence outcomes of aspirin treatment.

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Sinus surgery improves lower respiratory tract reactivity during aspirin desensitization for AERD

Cited by 24 publications

References 11 publications

The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma & Immunology

The role of aspirin desensitization followed by oral aspirin therapy in managing patients with aspirin-exacerbated respiratory disease: A Work Group Report from the Rhinitis, Rhinosinusitis and Ocular Allergy Committee of the American Academy of Allergy, Asthma & Immunology

Biomarkers for predicting response to aspirin therapy in aspirin‐exacerbated respiratory disease

Biomarkers for predicting response to long‐term high dose aspirin therapy in aspirin‐exacerbated respiratory disease

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