Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease

Abstract

Background-Nasal polyps influence the burden of aspirin exacerbated respiratory disease (AERD) by contributing to eicosanoid production. AERD is diagnosed through graded aspirin challenges. It is not known how sinus surgery affects aspirin challenge outcomes.Objective-To investigate the effects of endoscopic sinus surgery (ESS) on aspirin-induced reaction severity and on the levels of eicosanoids associated with these reactions.Methods-Twenty-eight AERD patients were challenged with aspirin before and 3-4 weeks after ESS. Respiratory parameters and plasma and urine levels of eicosanoids were compared before and after challenges.Results-Before ESS, AERD diagnosis was confirmed in all study patients by aspirin challenges that resulted in hypersensitivity reactions. After ESS, reactions to aspirin were less severe in all patients and twelve out of twenty-eight patients (43%, p<0.001) had no detectable reaction. A lack of clinical reaction to aspirin was associated with lower peripheral blood eosinophilia [0.1 K/μL

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

“…11 In this study, we observed that FESS before aspirin desensitization is associated with diminished aspirin-induced lower airway reactions during aspirin challenge/desensitization in patients with AERD. This finding is similar to that in the recent work by Jerschow et al 9 From a physiologic perspective, this suggests that nasal polyp tissue contributes to the severity of aspirin-induced reactions. In practice, this finding has relevance for patient safety and selecting the optimal timing of aspirin desensitization for AERD.…”

“…The rationale for this is 2-fold: (1) high-dose aspirin maintenance after FESS can delay or obviate the need for revision sinus surgery and prolong the benefits of surgery for these patients and (2) aspirin use is contraindicated during FESS and desensitization would need to be repeated following surgical intervention. 7,8 Recently, Jerschow et al 9 reported that, in a predominantly African-American and Hispanic/Latino population, aspirin-induced reactions were less severe during desensitizations that occurred shortly after FESS. In this study, we applied similar methodology to a more generalized population.…”

Endoscopic sinus surgery improves aspirin treatment response in aspirin‐exacerbated respiratory disease patients

“…We previously reported that aspirin challenges are more likely to be asymptomatic after recent ESS. 31 In this study we also found that recent ESS was likely to improve aspirin desensitization and treatment outcomes, especially in patients with high baseline serum IgE levels. Of note, peripheral blood eosinophil counts were observed to decrease significantly after ESS.…”

Impact of sinus surgery on type 2 airway and systemic inflammation in asthma

“…To our knowledge, this is the first study demonstrating the short/long-term impact of sinus surgery on airway/systemic type 2 inflammation in asthma patients with eosinophilic CRSwNP. Recently, Jerschow et al reported the short-term study that the type 2 inflammation, such as FeNO and blood eosinophil counts, were decreased after the sinus surgery in patients with AERD (31). Because our study evaluated not only short-term but also evaluated long-term impact of ESS on type 2 inflammation, the present study reinforced the pathophysiology regarding the association and management of airway/systemic type 2 inflammation between the upper and lower airways.…”