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Pathogenesis of NsAID-induced reactions in aspirin-exacerbated respiratory disease

World Journal of Otorhinolaryngology-Head and Neck surgery 2018年第3期4卷 162-168页

作者： Tanya M. Laidlaw Brigham and Women’s Hospital Division of RheumatologyImmunology and AllergyBostonMAUSA Harvard Medical school BostonMAUSA

It is well-established that following ingestion of aspirin or any other inhibitor of cyclooxygenase-1, patients with samter’s disease, or aspirin-exacerbated respiratory disease (AERD) develop the sudden onset of worsening respiratory clinical symptoms, which usually in-volves nasal congestion, rhinorrhea, wheezing and bronchospasm. Gastrointestinal distress, nausea, a pruritic rash and angioedema can also occasionally develop. However, the underlying pathologic mechanism that drives these clinical reactions remains elusive. Pretreatment with medications that inhibit the leukotriene pathway decreases the severity of clinical reactions, which points to the involvement of cysteinyl leukotrienes (cysLTs) in the pathogenesis of these aspirin-induced reactions. Furthermore, studies of aspirin challenges in carefully-phenotyped patients with AERD have confirmed that both proinflammatory lipid mediators, predominantly cysLTs and prostaglandin (PG) D 2, and the influx of effector cells to the respiratory tissue, contribute to symptom development during aspirin-induced reactions. Mast cells, which have been identified as the major cellular source of cysLTs and PGD 2, are likely to be major participants in the acute reactions, and are an attractive target for future pharmacotherapies in AERD. Although several recent studies support the role of platelets as inflammatory effector cells and as a source of cysLT overproduction in AERD, it is not yet clear whether platelet activation plays a direct role in the development of the aspirin-induced reactions. To further our understanding of the pathogenesis of aspirin-induced reactions in AERD, and to broaden the pharmacotherapeutic options available to these patients, additional investigations with targeted clinical trials will be required.

关键词： Aspirin-exacerbated respiratory disease(AERD) Nasal polyps samter’s triad Pathogenesis Cysteinyl leukotrienes Prostaglandins Mast cell

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Olfactory outcomes in the management of aspirin exacerbated respiratory disease related chronic rhinosinusitis

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World Journal of Otorhinolaryngology-Head and Neck surgery 2020年第4期6卷 207-213页

作者： Daniel B.spielman Jonathan Overdevest David A.Gudis Departm ent of Otolaryngology-Head and Neck surgery Columbia University Medical CenterNew YorkNY10032USA

Patients with aspirin exacerbated respiratory disease(AERD)experience a severe and recalcitrant form of chronic rhinosinusitis with nasal polyposis(CRswNP)and asthma,which are exacerbated by aspirin/NsAID ingestion.As compared with aspirin-tolerant CRswNP,patients with AERD experience more severe olfactory dysfunction,which is one of the key contributors to the observed decrease in quality of life(QOL)in this disease.The objective of this paper is to review the published olfactory outcomes observed with various treatment modalities.

关键词： Aspirin exacerbated respiratory disease AERD samter’s triad Olfaction hyposmia Endoscopic sinus surgery Aspirin desensitization NsAID

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维普期刊数据库

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The importance of timely diagnosis of aspirin-exacerbated respiratory disease for patient health and safety

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World Journal of Otorhinolaryngology-Head and Neck surgery 2020年第4期6卷 203-206页

作者： Kathleen Buchheit Jillian C.Bensko Erin Lewis Deborah Gakpo Tanya M.Laidlawa Deportment of Medicine Division of Allergy and Clinical ImmunologyBrishom and Women's HospitalBostonMAUSA Harvard Medical school BostonM AUSA

Backgroud:Aspirin-exacerbated respiratory disease(AERD)is a difficult-to-treat syndrome where timely diagnosis and initiation of disease-specific therapies are pertinent to improved patient outcomes.Objective:To characterize the most common timeline for development of the clinical triad[asthma,nasal polyposis,and reactions to nonsteroidal anti-inflammatory drugs(NsAIDs)],identify barriers to prompt diagnosis of AERD,and describe indications for an aspirin challenge to facilitate accurate diagnosis.Methods:six hundred ninety-seven patients with diagnosed AERD and history of at least one sinus surgery to remove nasal polyps were identified in the Brigham and Women’s Hospital AERD registry.Patient reported age at disease onset of asthma,nasal polyposis,and age of first NsAID reaction were obtained from 2013 to 2019 at enrollment.Results:Of the 697 patients identified,diagnosis of asthma preceded diagnosis of nasal polyposis and first NsAID reaction,although there was considerable variability between patients.Conclusions:Prompt diagnosis of AERD is important for patient and provider education and improved care of this difficult-to-treat population of patients.Consider diagnostic aspirin challenge in patients without historical reactions to NsAIDs who have an otherwise compatible clinical history,specifically in patients who take daily low-dose aspirin,leukotriene modifiers,avoid NsAIDs,or who are severely symptomatic at baseline where it would be difficult to identify an acute worsening of symptoms.

关键词： Aspirin-exacerbated respiratory disease(AERD) Aspirin(acetylsalicylic acid AsA) Chronic rhinosinusitis with nasal polyps samter’s triad Anosmia Aspirin hypersensitivity Aspirin challenge NsAID hypersensitivity NsAID challenge

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