Safety and efficacy of Aspirin desensitization combined with long-term Aspirin therapy in Aspirin-exacerbated respiratory disease

OBJECTIVES: To assess the safety and efficacy of Aspirin desensitization combined with long-term Aspirin therapy in patients with Aspirinexacerbated respiratory disease (AERD). METHODS: We searched the PubMed, Ovid, Cochrane Library, and Google Scholar databases from inception to October 2018 for articles in English. We only included randomized controlled trials and parallel or cross-over studies in which adults with AERD were randomly assigned to undergo Aspirin desensitization and receive long-term Aspirin therapy or placebo. RESULTS: A total of 869 citations were retrieved, and 6 studies met the criteria for analysis. All studies indicated that nasal symptoms, asthma symptoms, or both improved significantly after Aspirin desensitization. In addition, most studies reported a decline in corticosteroid dosage (oral and inhaled). The 4 studies that reported nasal polyps did not demonstrate a change in nasal polyps with Aspirin therapy compared with placebo. The dropout rates in all studies reviewed ranged from 5.8% to 55.7%, and the most common adverse events were gastrointestinal symptoms. CONCLUSIONS: Clearly, Aspirin desensitization and treatment are beneficial for AERD patients, with relief of nasal symptoms, improvement in asthma control, decrease in daily corticosteroid use, and no fatal adverse events. However, the long-term adverse effects of Aspirin desensitization and optimal dosage of Aspirin merit further investigation

OBJETIVOS: Evaluar la seguridad y la eficacia de la desensibilización a la Aspirina junto con la terapia a largo plazo con Aspirina en sujetos con enfermedad respiratoria exacerbada por Aspirina (AERD). MÉTODOS: Se realizaron búsquedas en PUBMED, Ovid, Cochrane Library y Google Scholar desde el inicio hasta octubre de 2018, e impusimos una restricción del inglés en el idioma de publicación. Solo se incluyeron ensayos controlados aleatorios, paralelos o cruzados, en los cuales los sujetos adultos con AERD se asignaron al azar para recibir desensibilización a la Aspirina y terapia con Aspirina a largo plazo o placebo. RESULTADOS: Se recuperaron un total de 869 citas y 6 estudios cumplieron con los criterios de análisis. Todos los estudios indicaron que los síntomas nasales, los síntomas del asma o ambos mejoraron significativamente después del tratamiento de desensibilización con Aspirina. La mayoría de los estudios mostraron una disminución de la dosis de corticosteroides, orales o inhalados que necesitaron los pacientes. Los cuatro estudios que documentaron pólipos nasales no demostraron un cambio en los pólipos nasales con la terapia con Aspirina en comparación con el placebo. Las tasas de deserción en todos los estudios revisados varían entre el 5,8% y el 55,7% y los efectos adversos más comunes fueron los síntomas gastrointestinales. CONCLUSIONES: Claramente, la desensibilización y el tratamiento con Aspirina son beneficiosos para los pacientes con AERD, con una reducción de los síntomas nasales, mejoras en el control del asma y una disminución del uso diario de corticosteroides, sin eventos adversos fatales. Sin embargo, los efectos secundarios a largo plazo de la desensibilización a la Aspirina y la dosis óptima de la Aspirina merecen más investigación

Changes in fractional exhaled nitric oxide levels after bronchial challenge with Aspirin in patients with Aspirin-induced asthma

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Cofactors and comorbidities in patients with aspirin/NSAID hypersensitivity

Hypersensitivity reactions to aspirin and other NSAIDs occur in individuals genetically predisposed and exhibit different clinical manifestations, especially respiratory, cutaneous, and generalised. Five different phenotypes define distinct clinical pictures: aspirin-exacerbated respiratory disease, aspirin/NSAID cutaneous disease, NSAID-induced urticaria, angio-oedema and anaphylaxis, single NSAID reactions, and delayed reactions. They are observed more frequently in middle-aged women, and in atopic individuals. While ASA/NSAID hypersensitivity shares comorbidities with asthma, chronic rhinosinusitis, nasal polyposis, chronic urticaria and angio-oedema, ASA and other NSAIDs can also be cofactors for other clinically relevant conditions, especially food-dependent exercise-induced anaphylaxis, angio-oedema induced by angiotensin-converting enzyme inhibitors, and oral mite anaphylaxis. Awareness on these relationships is required for the correct diagnosis, classification, and treatment of affected patients (AU)

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Fenotipos del asma, ¿son importantes? / Asthma Phenotypes; Do They Matter?

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Recent advance in investigation of gene polymorphisms in Japanese patients with aspirin-exacerbated respiratory disease

Aspirin-exacerbated respiratory disease (AERD) is a complex clinical syndrome characterised by severe asthmatic attack upon treatment with aspirin and/or non-steroidal anti-inflammatory drugs (NSAIDs). Genetic predisposition has been considered as a crucial determinant and candidate genes have concentrated especially on cysteinyl leukotrienes (LTs)- related genes as the inhibitory action of aspirin and NSAIDs on cyclooxygenase activity may cause overproduction of cysteinyl LTs. However, conflicting results have been reported, in parallel with replication studies in different ethnic groups. Thus, future areas of investigations need to focus on comprehensive approaches towards the discovery of other genetic biomarkers. Unfortunately, few papers have been reported about gene polymorphisms in Japanese patients with AERD. Here, we described on our recent genetic investigations on B2ADR, IL-13, IL-17A, CYP2C19, TBXA2R, CRTH2 and HSP70. This review indicates potential genetic biomarkers contributing to the early diagnosis of AERD, which may include CYP2C19 and HSP70 gene polymorphisms, and future validation studies in independent population are required to provide reassurance about our findings

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Aspirin desensitization achieved after Omalizumab treatment in a patient with Aspirin-exacerbated urticaria and respiratory disease

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Aspirin does not preferentially potentiate IgE dependent basophil CD63 upregulation in patients with food-dependent exercise-induced anaphylaxis

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Tolerability to Etoricoxib in Patients With Aspirin-Exacerbated Respiratory Disease

Introducción: El uso de inhibidores selectivos de la cicloxigenasa-2 (COX-2) como alternativa a la aspirina y otros analgésicos antiinflamatorios no-esteroideos (AINEs) puede ser una alternativa terapeútica para pacientes con enfermedad respiratoria exacerbada por aspirina (EREA). Objetivo: Evaluar la tolerancia a etericoxib, un inhibidor de segunda generación de la COX-2 con alta selectividad in vitro para COX-2, en pacientes con EREA. Para ello se realizó una revisión retrospectiva de pacientes con sospecha de intolerancia a aspirina vistos entre 10/2007 y 04/2012. Se realizaron pruebas de provocación oral controladas con dosis crecientes de aspirina y etericoxib en tres días diferentes. Resultados: De los 262 pacientes con sospecha de intolerancia a aspirina, 248 fueron sometidos a prueba de provocación con aspirina y 122 (49,2%) mostraron un resultado positivo. En 104 de estos, el etericoxib se testó como un medicamento alternativo y fue tolerado en todos, excepto en 3 pacientes (2,9%) que desarrollaron una reacción asmática. Conclusión: El etericoxib se toleró en la mayoría de los pacientes estudiados. Es recomendable una prueba de provocación antes de indicar este medicamento en el tratamiento de pacientes con EREA (AU)

Background: The use of selective cyclooxygenase (COX) 2 inhibitors as an alternative to aspirin and other nonsteroidal anti-inflamatory drugs (NSAIDs) has been suggested for patients with aspirin-exacerbated respiratory disease (AERD). Objective: To evaluate tolerability to etoricoxib, a second-generation COX-2 inhibitor with high in vitro selectivity for COX-2 in patients with AERD. Methods: We conducted a retrospective review of patients with suspected aspirin intolerance seen between October 2007 and April 2012. Single-blind, placebo-controlled oral challenges with increasing doses of aspirin and etoricoxib were performed on 3 different days. Results: Of 262 patients with suspected aspirin intolerance, 248 underwent challenge testing with aspirin and 122 (49.2%) showed positive test results. In 104 of these aspirin-sensitive patients, etoricoxib was tested as an alternative drug and was tolerated in all but 3 (2.9%), who developed a positive asthmatic reaction. Conclusions: The highly selective COX-2 inhibitor etoricoxib was tolerated in most but not all patients tested. An oral provocation test is therefore recommended before prescribing etoricoxib for patients with AERD (AU)

Aspirin tolerance following omalizumab therapy in a patient with aspirin-exacerbated respiratory disease

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Prevalence of aspirin-exacerbated respiratory disease in patients with asthma in Turkey: A cross-sectional survey

Background: There are no country-based data focused on aspirin (ASA)-exacerbated respiratory disease (AERD) in Turkey. Objective: To assess the prevalence of AERD in adult patients with asthma. Methods: A structured questionnaire was administered via face-to-face interview by a specialist in pulmonology/allergy at seven centres across Turkey. Results: A total of 1344 asthma patients (F/M: 1081/263: 80.5%/19.5%, mean age: 45.7±14.2 years) were enrolled. Atopy rate was 47%. Prevalence of allergic rhinitis, chronic rhinosinusitis/rhinitis, and nasal polyposis (NP) were 49%, 69% and 20%, respectively. Of 270 patients with NP, 171 (63.3%) reported previous nasal polypectomy and 40 (25%) had a history of more than three nasal polypectomies. Aspirin hypersensitivity was diagnosed in 180 (13.6%) asthmatic patients, with a reliable history in 145 (80.5%), and oral ASA provocation test in 35(19.5%) patients. Clinical presentations of ASA hypersensitivity were respiratory in 76% (n = 137), respiratory/cutaneous in 15% (n = 27), and systemic in 9% (n = 16) of the patients. Multivariate analysis indicated that a family history of ASA hypersensitivity (p: 0.001, OR: 3.746,95% CI: 1.769-7.929), history of chronic rhinosinusitis/rhinitis (p: 0.025, OR: 1.713, 95% CI:1.069- 2.746) and presence of NP (p < 0.001, OR: 7.036, 95% CI: 4.831---10.247) were independent predictors for AERD(AU)

Factores de riesgo de asma de inicio entre los 12 y 40 años. Resultados del estudio FENASMA / Risk Factors for Asthma Onset Between the Ages of 12 and 40. Results of the FENASMA Study

Objetivos: Describir el perfil clínico de los pacientes con asma e identificar posibles factores de riesgopara su desarrollo en sujetos mayores de 12 años.Métodos: Estudio multicéntrico de casos y controles. Se reclutó como casos a sujetos entre 12 y 40 añoscon diagnóstico de asma, con inicio de los síntomas después de los 12 años. Se seleccionó como controlesa sujetos entre 12 y 40 años que no tenían asma durante la infancia y que no presentaban síntomas deasma en el momento de realizar el estudio.Resultados: Se evaluó a 923 sujetos, 247 casos y 671 controles. El 54,9% de ellos eran mujeres. La media deedad de los casos era 28,3±8,2 y la de los controles, 30,8±7,1 años (p < 0,001). En el análisis de regresiónlogística se observó que los factores determinantes de la presencia de asma fueron la hipersensibilidada animales o a otros alérgenos, la presencia de rinitis, los antecedentes familiares de asma, la profesiónde riesgo/exposición a irritantes y la hipersensibilidad/intolerancia a AINE. En dicho análisis se demostrótambién que la edad era un factor de protección, así como el nivel de estudios.Conclusiones: Los factores de riesgo para el desarrollo de asma en la edad adulta son la hipersensibilidada animales o a otros alérgenos, la rinitis, los antecedentes familiares de asma, la profesión deriesgo/exposición a irritantes y la hipersensibilidad/intolerancia a AINE, mientras que la edad y el nivelde estudios son factores protectores (AU)

Objectives: To describe the clinical profile of patients with asthma and to identify possible risk factors forits development in subjects over the age of 12.Patients and methods: Amulticenter study of cases and controls. Recruited for inclusion were case subjectsbetween the ages of 12 and 40 diagnosed with asthma, with an onset of symptoms after the age of 12.Control subjects were selected, with ages between 12 and 40, who did not have childhood asthma anddid not present symptoms of asthma at the time of the study.Results: We evaluated 923 subjects: 247 cases and 671 controls. 54.9% were women. Mean age of thecases was 28.3±8.2; mean age of controls was 30.8±7.1 (p < 0.001). In the logistic regression analysis,it was observed that the determining factors for the of the presence of asthma were hypersensitivity toanimals or other allergens, presence of rhinitis, family history of asthma, occupational risk/exposure toirritants and the hypersensitivity/intolerance to NSAIDs. In said analysis, it was also demonstrated that age was a protection factor, as well as level of education. Conclusions: The risk factors for the development of asthma at an adult age are hypersensitivity to animalsor other allergens, rhinitis, family history of asthma, occupational risk/exposure to irritants and thehypersensitivity/intolerance to NSAIDs, while age and level of education are protection factors (AU)

Detección, prevención, registro y resolución de PRM relacionados con asma en Bizkaia / No disponible

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Inhibidores de la COX-2 en la enfermedad respiratoria exacerbada por aspirina (EREA) / No disponible

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