[Aspirin-exacerbated respiratory disease]

Abstract

Aspirin sensitivity is an important underlying disease in patients with nasal polyps, intrinsic asthma or urticaria. The terms "Aspirin- (or analgetics-) induced asthma" or "Aspirin-exacerbated respiratory disease" (AERD) describe the syndrome of chronic rhinosinusititis, polyposis nasi, asthma and acute reaction after ingestion of non-steroid antiinflammatory drugs (NSAID). The disease affects mainly women in the third decade or older. Nasal symptoms often appear many years previous to asthma and acute intolerance reactions. Nasal polyps not rarely require surgical interventions. However, polyps often relapse after weeks or few months after resection. The intrinsic asthma is difficult to control and patients often require treatment with oral steroids. The disease is not caused by the ingestion of NSAID, the sensitivity represents a phenomenon of the underlying metabolic disorder. Aspirin sensitivity is not an allergic disease based on IgE-mediated reactions. In contrast it is due to a metabolic overexpression of cysteinyl leucotrienes. Thus, skin tests and specific antibodies in the blood are always negative. Recent studies indicate that NSAID sensitivity may be proven and differentiated by sophisticated in vitro tests. However, nasal, bronchial, and oral provocation testing remains the standard of diagnosis. Aspirin desensitization is the most relevant therapeutical approach which improves nasal symptoms in the majority of patients and may stabilize intrinsic asthma.