Aspirin-induced asthma: Advances in pathogenesis, diagnosis, and management

• Published in: Journal of allergy and clinical immunology 2003-05, Vol.111 (5), p.913-921
• Main Authors: Szczeklik, Andrew, Stevenson, Donald D.
• Format: Article
• Language: English
• Subjects: Allergies; Aspirin; Aspirin - adverse effects; aspirin desensitization; Aspirin-induced asthma; Asthma; Asthma - chemically induced; Asthma - diagnosis; Asthma - therapy; Biological and medical sciences; Chronic obstructive pulmonary disease, asthma; chronic sinusitis; COX-1 and 2 inhibitors; Disease; Drug dosages; Drug therapy; Drug toxicity and drugs side effects treatment; Humans; Lipoxygenase - physiology; Medical sciences; nasal polyposis; Nonsteroidal anti-inflammatory drugs; Nose; Pathogenesis; Pharmacology. Drug treatments; Pneumology; Population; Prostaglandin-Endoperoxide Synthases - physiology; Sinuses; Surgery; Toxicity: respiratory system, ent, stomatology; Womens health
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1067/mai.2003.1487

In some asthmatic individuals, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit cyclooxygen-ase 1 (COX-1) exacerbate the condition. This distinct clinical syndrome, called aspirin-induced asthma (AIA), is characterized by an eosinophilic rhinosinusitis, nasal polyposis, aspirin sensitivity, and asthma. There is no in vitro test for the disorder, and diagnosis can be established only by provocation challenges with aspirin or NSAIDs. Recent major advances in the molecular biology of eicosanoids, exemplified by the cloning of 2 cysteinyl leukotriene receptors and the discovery of a whole family of cyclooxygenase enzymes, offer new insights into mechanisms operating in AIA. The disease runs a protracted course even if COX-1 inhibitors are avoided, and the course is often severe, many patients requiring systemic corticosteroids to control their sinusitis and asthma. Aspirin and NSAIDs should be avoided, but highly specific COX-2 inhibitors, known as coxibs , are well tolerated and can be safely used. Aspirin desensitization, followed by daily aspirin treatment, is a valuable therapeutic option in most patients with AIA, particularly those with recurrent nasal polyposis or overdependence on systemic corticosteroids. (J Allergy Clin Immunol 2003;111:913-21.)