Asthma with hypersensitivity to aspirin
Nizankowska-Mogilnicka, E.
Polski Merkuriusz Lekarski Organ Polskiego Towarzystwa Lekarskiego 14(84): 561-565
2003
ISSN/ISBN: 1426-9686 PMID: 14524272 Document Number: 555400
Aspirin-induced asthma (AIA) is a distinct clinical entity characterised by hypersensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) typically occurring in the form of asthma and severe rhinosinusitis. Its prevalence is about 10%, but AIA probably is underdiagnosed. The diagnosis can only be established with certainty by challenge tests, using increasing doses of aspirin. The crucial cell in AIA is the eosinophil, while the role of mast cell is more elusive. At the biochemical level, AIA is distinguished by profound underlying arachidonic acid disturbances. An overproduction of leukotrienes was observed in patients with aspirin hypersensitivity at baseline and following aspirin challenge. In some patients altered prostaglandin release following aspirin was encountered. The inhibition of COX-1, but not COX-2, was shown to precipitate post-challenge symptoms precipitated by aspirin. The new insights into eicosanoid molecular biology and genetics have recently emerged. The patients with aspirin-sensitive asthma require often prolonged oral, inhaled and nasal corticotherapy. Antileukotrienes also can be used. Aspirin and NSAIDs should be avoided. Nevertheless, highly specific COX-2 inhibitors are well tolerated. Aspirin desensitisation, followed by daily aspirin treatment, is a valuable therapeutic option.