Aspirin intolerance and the cyclooxygenase-leukotriene pathways.
OBJECTIVE
In up to 10% of patients with bronchial asthma, aspirin and other nonsteroidal antiinflammatory drugs precipitate asthmatic attacks. This is a hallmark of a distinct clinical syndrome that develops according to a characteristic sequence of symptoms. Here we discuss its clinical picture and management as related to the abnormalities in arachidonic acid transformations.


RESULTS
At the biochemical level, the characteristic feature is profound alteration in eicosanoid biosynthesis and metabolism. Major advances in the molecular biology of eicosanoids, exemplified by the cloning of cysteinyl-leukotriene receptors and discovery of a whole family of cyclooxygenase enzymes, offer new insights into mechanisms operating in aspirin-induced asthma. Clinical interest has been enhanced by the introduction into therapy of highly specific cyclooxygenase-2 inhibitors and antileukotriene drugs.


CONCLUSIONS
Recent studies have improved our understanding of mechanisms operating in asthma and unvieled the role of eicosanoid mediators in pulmonary disease.
Szczeklik
Andrew
A
Department of Medicine, Jagiellonian University School of Medicine, Kraków, Poland. mmszczek@cyf-kr-edu.pl
Sanak
Marek
M
Nizankowska-Mogilnicka
Ewa
E
Kiełbasa
Bogumila
B
D001241:Aspirin / Q000009:adverse effects*; D001249:Asthma / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D003888:Desensitization, Immunologic; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D015289:Leukotrienes / Q000378:metabolism; D044045:Lipoxins / Q000502:physiology; D008407:Mast Cells / Q000502:physiology; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases; D012220:Rhinitis / Q000453:epidemiology; D012852:Sinusitis / Q000453:epidemiology
D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D015289:Leukotrienes; D044045:Lipoxins; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D001241:Aspirin