Aspirin exacerbated respiratory disease

INTRODUCTION AND TERMINOLOGY

Aspirin exacerbated respiratory disease (AERD) refers to the combination of:

Asthma

Chronic rhinosinusitis (CRS) with nasal polyposis

Reactions to aspirin (acetylsalicylic acid, ASA) and other COX-1 inhibiting nonsteroidal antiinflammatory drugs (NSAIDs), in which symptoms typically begin 30 minutes to 3 hours after ingestion and typically involve bronchospasm and nasal congestion

Patients with AERD are also described as having aspirin-sensitive asthma or aspirin intolerance, although these terms refer to just one component of the disorder. The term AERD places emphasis on the upper and lower respiratory disease as the fundamental disorder and NSAIDs as an exacerbating factor rather than the underlying cause [1,2]. In keeping with this, avoidance of NSAIDs by these patients does not result in resolution of asthma or CRS.

                         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2014. | This topic last updated: Dec 18, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Fahrenholz JM. Natural history and clinical features of aspirin-exacerbated respiratory disease. Clin Rev Allergy Immunol 2003; 24:113.
  2. Berges-Gimeno MP, Simon RA, Stevenson DD. The natural history and clinical characteristics of aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 2002; 89:474.
  3. Samter M, Beers RF Jr. Intolerance to aspirin. Clinical studies and consideration of its pathogenesis. Ann Intern Med 1968; 68:975.
  4. Berkes EA. Anaphylactic and anaphylactoid reactions to aspirin and other NSAIDs. Clin Rev Allergy Immunol 2003; 24:137.
  5. Szczeklik A, Nizankowska E, Duplaga M. Natural history of aspirin-induced asthma. AIANE Investigators. European Network on Aspirin-Induced Asthma. Eur Respir J 2000; 16:432.
  6. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004; 328:434.
  7. Hedman J, Kaprio J, Poussa T, Nieminen MM. Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol 1999; 28:717.
  8. Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis, diagnosis, and management. J Allergy Clin Immunol 2003; 111:913.
  9. Vally H, Taylor ML, Thompson PJ. The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Thorax 2002; 57:569.
  10. Weber RW, Hoffman M, Raine DA Jr, Nelson HS. Incidence of bronchoconstriction due to aspirin, azo dyes, non-azo dyes, and preservatives in a population of perennial asthmatics. J Allergy Clin Immunol 1979; 64:32.
  11. Shore SA, Austen KF, Drazen JM. Lung biology in health and disease: Lung cell biology. In: Eicosanoids and the lung, L'Enfant C, Massaro D (Eds), Marcel Dekker, New York 1989.
  12. Laitinen LA, Laitinen A, Haahtela T, et al. Leukotriene E4 and granulocytic infiltration into asthmatic airways. Lancet 1993; 341:989.
  13. Dahlén B. Treatment of aspirin-intolerant asthma with antileukotrienes. Am J Respir Crit Care Med 2000; 161:S137.
  14. Bochenek G, Nagraba K, Nizankowska E, Szczeklik A. A controlled study of 9alpha,11beta-PGF2 (a prostaglandin D2 metabolite) in plasma and urine of patients with bronchial asthma and healthy controls after aspirin challenge. J Allergy Clin Immunol 2003; 111:743.
  15. Antczak A, Montuschi P, Kharitonov S, et al. Increased exhaled cysteinyl-leukotrienes and 8-isoprostane in aspirin-induced asthma. Am J Respir Crit Care Med 2002; 166:301.
  16. Knapp HR, Sladek K, Fitzgerald GA. Increased excretion of leukotriene E4 during aspirin-induced asthma. J Lab Clin Med 1992; 119:48.
  17. Ferreri NR, Howland WC, Stevenson DD, Spiegelberg HL. Release of leukotrienes, prostaglandins, and histamine into nasal secretions of aspirin-sensitive asthmatics during reaction to aspirin. Am Rev Respir Dis 1988; 137:847.
  18. Daffern PJ, Muilenburg D, Hugli TE, Stevenson DD. Association of urinary leukotriene E4 excretion during aspirin challenges with severity of respiratory responses. J Allergy Clin Immunol 1999; 104:559.
  19. Lee TH, Woszczek G, Farooque SP. Leukotriene E4: perspective on the forgotten mediator. J Allergy Clin Immunol 2009; 124:417.
  20. Guilemany JM, Roca-Ferrer J, Mullol J. Cyclooxygenases and the pathogenesis of chronic rhinosinusitis and nasal polyposis. Curr Allergy Asthma Rep 2008; 8:219.
  21. Stevenson DD, Zuraw BL. Pathogenesis of aspirin-exacerbated respiratory disease. Clin Rev Allergy Immunol 2003; 24:169.
  22. Cai Y, Bjermer L, Halstensen TS. Bronchial mast cells are the dominating LTC4S-expressing cells in aspirin-tolerant asthma. Am J Respir Cell Mol Biol 2003; 29:683.
  23. Cowburn AS, Sladek K, Soja J, et al. Overexpression of leukotriene C4 synthase in bronchial biopsies from patients with aspirin-intolerant asthma. J Clin Invest 1998; 101:834.
  24. Nasser S, Christie PE, Pfister R, et al. Effect of endobronchial aspirin challenge on inflammatory cells in bronchial biopsy samples from aspirin-sensitive asthmatic subjects. Thorax 1996; 51:64.
  25. Fischer AR, Rosenberg MA, Lilly CM, et al. Direct evidence for a role of the mast cell in the nasal response to aspirin in aspirin-sensitive asthma. J Allergy Clin Immunol 1994; 94:1046.
  26. Adamjee J, Suh YJ, Park HS, et al. Expression of 5-lipoxygenase and cyclooxygenase pathway enzymes in nasal polyps of patients with aspirin-intolerant asthma. J Pathol 2006; 209:392.
  27. Sanak M, Simon HU, Szczeklik A. Leukotriene C4 synthase promoter polymorphism and risk of aspirin-induced asthma. Lancet 1997; 350:1599.
  28. Sanak M, Pierzchalska M, Bazan-Socha S, Szczeklik A. Enhanced expression of the leukotriene C(4) synthase due to overactive transcription of an allelic variant associated with aspirin-intolerant asthma. Am J Respir Cell Mol Biol 2000; 23:290.
  29. Sousa AR, Parikh A, Scadding G, et al. Leukotriene-receptor expression on nasal mucosal inflammatory cells in aspirin-sensitive rhinosinusitis. N Engl J Med 2002; 347:1493.
  30. Sanak M, Levy BD, Clish CB, et al. Aspirin-tolerant asthmatics generate more lipoxins than aspirin-intolerant asthmatics. Eur Respir J 2000; 16:44.
  31. Gaber F, Daham K, Higashi A, et al. Increased levels of cysteinyl-leukotrienes in saliva, induced sputum, urine and blood from patients with aspirin-intolerant asthma. Thorax 2008; 63:1076.
  32. Laidlaw TM, Kidder MS, Bhattacharyya N, et al. Cysteinyl leukotriene overproduction in aspirin-exacerbated respiratory disease is driven by platelet-adherent leukocytes. Blood 2012; 119:3790.
  33. Israel E, Fischer AR, Rosenberg MA, et al. The pivotal role of 5-lipoxygenase products in the reaction of aspirin-sensitive asthmatics to aspirin. Am Rev Respir Dis 1993; 148:1447.
  34. Christie PE, Smith CM, Lee TH. The potent and selective sulfidopeptide leukotriene antagonist, SK&F 104353, inhibits aspirin-induced asthma. Am Rev Respir Dis 1991; 144:957.
  35. Nasser SM, Bell GS, Foster S, et al. Effect of the 5-lipoxygenase inhibitor ZD2138 on aspirin-induced asthma. Thorax 1994; 49:749.
  36. Picado C, Fernandez-Morata JC, Juan M, et al. Cyclooxygenase-2 mRNA is downexpressed in nasal polyps from aspirin-sensitive asthmatics. Am J Respir Crit Care Med 1999; 160:291.
  37. Kowalski ML, Pawliczak R, Wozniak J, et al. Differential metabolism of arachidonic acid in nasal polyp epithelial cells cultured from aspirin-sensitive and aspirin-tolerant patients. Am J Respir Crit Care Med 2000; 161:391.
  38. Pierzchalska M, Szabó Z, Sanak M, et al. Deficient prostaglandin E2 production by bronchial fibroblasts of asthmatic patients, with special reference to aspirin-induced asthma. J Allergy Clin Immunol 2003; 111:1041.
  39. Sestini P, Armetti L, Gambaro G, et al. Inhaled PGE2 prevents aspirin-induced bronchoconstriction and urinary LTE4 excretion in aspirin-sensitive asthma. Am J Respir Crit Care Med 1996; 153:572.
  40. Ying S, Meng Q, Scadding G, et al. Aspirin-sensitive rhinosinusitis is associated with reduced E-prostanoid 2 receptor expression on nasal mucosal inflammatory cells. J Allergy Clin Immunol 2006; 117:312.
  41. Corrigan CJ, Napoli RL, Meng Q, et al. Reduced expression of the prostaglandin E2 receptor E-prostanoid 2 on bronchial mucosal leukocytes in patients with aspirin-sensitive asthma. J Allergy Clin Immunol 2012; 129:1636.
  42. Babu KS, Salvi SS. Aspirin and asthma. Chest 2000; 118:1470.
  43. Mastalerz L, Sanak M, Gawlewicz-Mroczka A, et al. Prostaglandin E2 systemic production in patients with asthma with and without aspirin hypersensitivity. Thorax 2008; 63:27.
  44. Lee SH, Rhim T, Choi YS, et al. Complement C3a and C4a increased in plasma of patients with aspirin-induced asthma. Am J Respir Crit Care Med 2006; 173:370.
  45. Williams AN, Simon RA, Woessner KM, Stevenson DD. The relationship between historical aspirin-induced asthma and severity of asthma induced during oral aspirin challenges. J Allergy Clin Immunol 2007; 120:273.
  46. Dahlén B, Nizankowska E, Szczeklik A, et al. Benefits from adding the 5-lipoxygenase inhibitor zileuton to conventional therapy in aspirin-intolerant asthmatics. Am J Respir Crit Care Med 1998; 157:1187.
  47. Dahlén SE, Malmström K, Nizankowska E, et al. Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist: a randomized, double-blind, placebo-controlled trial. Am J Respir Crit Care Med 2002; 165:9.
  48. Lee DK, Haggart K, Robb FM, Lipworth BJ. Montelukast protects against nasal lysine-aspirin challenge in patients with aspirin-induced asthma. Eur Respir J 2004; 24:226.
  49. Steinke JW, Culp JA, Kropf E, Borish L. Modulation by aspirin of nuclear phospho-signal transducer and activator of transcription 6 expression: Possible role in therapeutic benefit associated with aspirin desensitization. J Allergy Clin Immunol 2009; 124:724.
  50. Katial RK, Strand M, Prasertsuntarasai T, et al. The effect of aspirin desensitization on novel biomarkers in aspirin-exacerbated respiratory diseases. J Allergy Clin Immunol 2010; 126:738.