Aspirin desensitization in patients with aspirin-induced and aspirin-tolerant asthma: a double-blind study.
BACKGROUND
Numerous open trials have demonstrated the beneficial clinical effects of aspirin desensitization (AD) in patients with aspirin-induced asthma (AIA). These beneficial effects might be attributable to aspirin's potent anti-inflammatory properties, but that supposition requires further corroboration.


OBJECTIVE
We sought to compare the clinical and biochemical responses to chronic oral AD in 20 patients with AIA and 14 patients with aspirin-tolerant asthma (ATA). All of the patients had chronic rhinosinusitis and nasal polyposis, and these responses were investigated in a pilot, double-blind, placebo-controlled study.


METHODS
Twelve patients with AIA and 6 patients with ATA were randomly assigned to receive 624 mg of aspirin, and 8 patients with AIA and 8 patients with ATA received placebo. Both aspirin and placebo were administered once daily for 6 months. Nasal symptoms, Sino-Nasal Outcome Test (SNOT20) scores, peak nasal inspiratory flows, Asthma Control Questionnaire scores, spirometric parameters, peak expiratory flows, blood eosinophilia, and corticosteroid doses were assessed on a monthly basis. Levels of urinary leukotriene E4 and the stable plasma prostaglandin (PG) D2 metabolite 9α,11β-PGF2 were evaluated at baseline and after 1, 3, 5, and 6 months.


RESULTS
Only the patients with AIA subjected to AD reported improvements in smell and reductions in sneezing and nasal blockade. The SNOT20 and Asthma Control Questionnaire scores of these patients decreased, and their peak nasal inspiratory flows increased. The dosages of inhaled corticosteroids were reduced. There were no changes in leukotriene E(4) or 9α,11β-PGF(2) levels after AD.


CONCLUSIONS
The clinically beneficial effects of AD on nasal and bronchial symptoms occurred only in the patients with AIA.
Medex, Bielsko-Biała, Poland.
Monika
M
Świerczyńska-Krępa
Division of Pulmonology, Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland.
Marek
M
Sanak
Division of Pulmonology, Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland.
Grażyna
G
Bochenek
Department of Otolaryngology, Jagiellonian University School of Medicine, Krakow, Poland.
Paweł
P
Stręk
Department of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland.
Adam
A
Ćmiel
Division of Pulmonology, Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland.
Anna
A
Gielicz
Division of Pulmonology, Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland.
Hanna
H
Plutecka
Division of Pulmonology, Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland.
Andrzej
A
Szczeklik
Division of Pulmonology, Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland. Electronic address: ewa.nizankowska@ghml.pl.
Ewa
E
Niżankowska-Mogilnicka
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology; D001241:Aspirin / Q000008:administration & dosage* / Q000276:immunology; D001249:Asthma / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D055963:Asthma, Aspirin-Induced / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D002908:Chronic Disease; D003888:Desensitization, Immunologic / Q000379:methods*; D015237:Dinoprost / Q000097:blood; D004311:Double-Blind Method; D004804:Eosinophils / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017999:Leukotriene E4 / Q000652:urine; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D010865:Pilot Projects; D015230:Prostaglandin D2 / Q000097:blood; D012220:Rhinitis / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D012852:Sinusitis / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D013147:Spirometry; D016896:Treatment Outcome
D000485:Allergens; D017999:Leukotriene E4; D015237:Dinoprost; D001241:Aspirin; D015230:Prostaglandin D2
Aspirin-induced asthma; aspirin-tolerant asthma; oral aspirin desensitization