title: Clinical features of asthmatic patients with increased urinary leukotriene E4 excretion (hyperleukotrienuria): Involvement of chronic hyperplastic rhinosinusitis with nasal polyposis.
abstract: BACKGROUND
  The urinary leukotriene E4 (U-LTE4) concentration is significantly increased in patients with aspirin-intolerant asthma (AIA). However, the relationship between the clinicopathogenetic factors of asthma and the U-LTE4 concentration remains undetermined.
  
  
  OBJECTIVE
  We sought to examine the clinical features of asthmatic patients with increased excretion levels of U-LTE4 (hyperleukotrienuria).
  
  
  METHODS
  We measured the U-LTE4 concentrations in 137 asthmatic patients (including 64 patients with AIA) who were in clinically stable condition. A U-LTE4 concentration of 150 pg/mg creatinine or greater (mean U-LTE4 + 3 SDs of normal healthy control subjects) was indicative of hyperleukotrienuria.
  
  
  RESULTS
  The basal concentration of U-LTE4 was significantly higher in the patients with AIA than in those with aspirin-tolerant asthma (ATA; median, 227.2 vs 90.3 pg/mg creatinine; P <.01). Compared with normal leukotrienuria in the patients with AIA, hyperleukotrienuria in the patients with AIA was associated with older age and decrease in pulmonary function. On the other hand, compared with normal leukotrienuria in the patients with ATA, hyperleukotrienuria in the patients with ATA was associated with severe asthma and chronic hyperplastic rhinosinusitis with nasal polyposis (CHRS/NP), which are well-known symptoms of the aspirin triad, as well as hypereosinophilia and anosmia. The patients with ATA with CHRS/NP excreted U-LTE4 at significantly high concentrations. There were significant decreases in the U-LTE4 concentrations before and after the sinus surgery in both the AIA and ATA groups (P <.05).
  
  
  CONCLUSIONS
  Cysteinyl leukotrienes are not strictly associated with aspirin intolerance itself but rather with clinical features, such as CHRS/NP, that are similar to those seen in AIA. CHRS/NP might be involved in cysteinyl leukotriene overproduction in asthmatic patients.
authors.affiliation: Clinical Research Center, National Sagamihara Hospital, Kanagawa, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Higashi
authors.forename: Masami
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Mita
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kawagishi
authors.forename: Toyota
authors.initials: T
authors.lastname: Ishii
authors.forename: Ai
authors.initials: A
authors.lastname: Higashi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Osame
authors.forename: Kazuo
authors.initials: K
authors.lastname: Akiyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D001249:Asthma / Q000503:physiopathology*; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006801:Humans; D017999:Leukotriene E4 / Q000652:urine*; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps; D012220:Rhinitis; D012852:Sinusitis
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D017999:Leukotriene E4; D001241:Aspirin