Topical nasal lysine aspirin in aspirin-sensitive and aspirin-tolerant chronic rhinosinusitis with nasal polyposis

Abstract

Chronic rhinosinusitis patients with nasal polyps can be aspirin sensitive or aspirin tolerant. The majority belong to the latter group. They tolerate intake of aspirin or other non-steroidal anti-inflammatory drugs, whereas aspirin-sensitive patients have an adverse reaction (asthma, rhinitis and/or urticaria). Diagnosis of aspirin sensitivity is important for the patient, but is rarely undertaken in routine ENT or respiratory medicine practice. Treatment of nasal polyps is by a combination of medical therapy and surgery. Oral and topical steroids form the mainstay of medical therapy, which is aimed at reducing inflammation and symptom improvement. Surgery helps with polyps causing severe nasal obstruction. Despite these therapies, recurrences are common in aspirin sensitive patients. Any adjunctive therapy to prevent or prolong recurrence would be welcome. One such possibility is topical nasal lysine-aspirin. This is an area under current debate and this non-systematic review aims to provide evidence of its use, to date, in aspirin sensitive and aspirin tolerant nasal polyp patients.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Parikh et al have reported on the use of daily topical nasal lysine‐aspirin in aspirin‐sensitive patients. Interestingly, with only 75 mg applied intranasally, this study provided high level evidence for alterations of cysLT receptors and weaker evidence levels for improved clinical outcomes using this regimen 1671,1688 …”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Parikh and Scadding 1054,1063 have reported on the use of topical nasal lysine in aspirin-sensitive patients. Interestingly, with only 75 mg applied intranasally, they were able to provide level 1b evidence for alterations of cysLT receptors and weaker evidence levels for improved clinical outcomes using this regimen 1054,1063 (Table VIII-15).…”

“…Parikh and Scadding 1054,1063 have reported on the use of topical nasal lysine in aspirin-sensitive patients. Interestingly, with only 75 mg applied intranasally, they were able to provide level 1b evidence for alterations of cysLT receptors and weaker evidence levels for improved clinical outcomes using this regimen 1054,1063 (Table VIII-15). In future trials, potential differences or clinical benefits of 100 mg vs 300 mg of aspirin or vice versa should be evaluated by randomized double-blind prospective dose-finding trials because the interpretation of the previously reported data in the literature are limited by their open study design.…”

The anti-inflammatory activity of licorice, a widely used Chinese herb

“…And, they are also centrally related to the pathogenesis of a large number of acute and chronic diseases, such as rheumatoid arthritis (Yang CLH et al 2013), colonic inflammatory response (Takhshid et al 2012) and periodontitis (Farhad et al 2013). However, the conventional therapies for inflammation, including steroids and nonsteroid anti-inflammatory drugs (NSAID) (Sostres et al 2010;Parikh & Scadding 2014;Carrasco-Pozo et al 2016), have shown many side effects and deficiencies. Considering this, licorice is an excellent alternative choice, due to the fact that it causes minimal disorders in the physiological functions of organism, has a nonspecific action and exerts a therapeutic action regardless of the direction of the pathological state.…”