title: Audit of nasal lysine aspirin therapy in recalcitrant aspirin exacerbated respiratory disease.
abstract: BACKGROUND
  Aspirin - exacerbated respiratory disease can prove difficult to control. Oral aspirin desensitization is effective, but has adverse effects and may not be cardio-protective at the high doses needed.
  
  
  OBJECTIVE
  To examine the effectiveness of aspirin administered in lower doses via the nose.
  
  
  METHODS
  An audit of 121 patients with aspirin exacerbated respiratory disease (AERD), 105 of whom were treated with intranasal lysine aspirin in gradually increasing doses following positive lysine aspirin challenge.
  
  
  RESULTS
  Treatment was associated with subjective symptomatic improvement or stabilization in 60 of 78 patients at 3 months and 19 of 27 at 12 months. Nasal inspiratory peak flow, olfaction, exhaled and nasal nitric oxide levels were significantly improved (p < 0.05 for all). Patients with positive skin prick tests and those with later onset (>40 years) AERD improved more than non-atopics and those with early onset AERD. Asthma outcomes over 1 year were assessed by questionnaire in 22 patients on lysine aspirin and in 20 who were positive on challenge but who either refused treatment or took it only briefly (less than or equal to 3 months). There was a significant decrease in emergency visits (p = 0.0182), hospitalization (p = 0.0074) and oral steroid use (p = 0.004) in those on nasal lysine aspirin for a year. Gastrointestinal side effects occurred in 3.8%, lower than those reported for oral aspirin therapy. Conclusions and Clinical Relevance This form of therapy might reduce the need for expensive monoclonal antibodies in AERD patients.
authors.affiliation: Department of Allergy & Rhinology, Royal National Throat, Nose and Ear Hospital, ,330 Grays Inn Road, London WC1X8DA, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Howe
authors.affiliation: Department of Allergy & Rhinology, Royal National Throat, Nose and Ear Hospital, ,330 Grays Inn Road, London WC1X8DA, UK.
authors.forename: Rita M
authors.initials: RM
authors.lastname: Mirakian
authors.affiliation: Department of Allergy & Rhinology, Royal National Throat, Nose and Ear Hospital, ,330 Grays Inn Road, London WC1X8DA, UK.
authors.forename: Prathap
authors.initials: P
authors.lastname: Pillai
authors.affiliation: Department of Allergy & Rhinology, Royal National Throat, Nose and Ear Hospital, ,330 Grays Inn Road, London WC1X8DA, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gane
authors.affiliation: Department of Allergy & Rhinology, Royal National Throat, Nose and Ear Hospital, ,330 Grays Inn Road, London WC1X8DA, UK.
authors.forename: Yvonne C
authors.initials: YC
authors.lastname: Darby
authors.affiliation: Department of Allergy & Rhinology, Royal National Throat, Nose and Ear Hospital, ,330 Grays Inn Road, London WC1X8DA, UK.
authors.forename: Glenis K
authors.initials: GK
authors.lastname: Scadding
keywords: Aspirin exacerbated respiratory disease; Late onset asthma; Lysine aspirin; Nasal polyposis
references.citation: PLoS One. 2012;7(6):e39875
references.pmid: 22768151
references.citation: Rhinology. 2010 Dec;48(4):426-32
references.pmid: 21442079
references.citation: J Allergy Clin Immunol. 2011 Nov;128(5):989-95.e1-8
references.pmid: 21958585
references.citation: Ann Allergy Asthma Immunol. 2001 Sep;87(3):177-80
references.pmid: 11570612
references.citation: J Allergy Clin Immunol. 2005 Feb;115(2):316-22
references.pmid: 15696087
references.citation: Ann Intern Med. 2009 Mar 17;150(6):379-86
references.pmid: 19293071
references.citation: Clin Exp Allergy. 2013 Aug;43(8):874-80
references.pmid: 23889241
references.citation: J Laryngol Otol. 2007 Dec;121(12):1156-60
references.pmid: 17697437
references.citation: Eur Respir J. 1997 Jul;10(7):1683-93
references.pmid: 9230267
references.citation: Curr Opin Allergy Clin Immunol. 2008 Feb;8(1):34-8
references.pmid: 18188015
references.citation: Thorax. 2000 Oct;55 Suppl 2:S87-90
references.pmid: 10992570
references.citation: Allergy Asthma Immunol Res. 2011 Jan;3(1):3-10
references.pmid: 21217919
references.citation: J Allergy Clin Immunol. 2013 Jan;131(1):110-6.e1
references.pmid: 23021878
references.citation: Clin Exp Allergy. 2001 Sep;31(9):1385-91
references.pmid: 11591188
references.citation: J Allergy Clin Immunol. 1999 Sep;104(3 Pt 1):559-64
references.pmid: 10482828
references.citation: J Allergy Clin Immunol. 2003 Jan;111(1):180-6
references.pmid: 12532116
references.citation: J Allergy (Cairo). 2012;2012:473863
references.pmid: 22927868
references.citation: Rhinology. 1990 Sep;28(3):191-6
references.pmid: 2251470
references.citation: J Allergy Clin Immunol. 2006 Oct;118(4):773-86; quiz 787-8
references.pmid: 17030227
references.citation: N Engl J Med. 2002 Nov 7;347(19):1493-9
references.pmid: 12421891
references.citation: Rhinology. 2007 Jun;45(2):144-7
references.pmid: 17708462
references.citation: Allergy. 2008 Sep;63(9):1228-34
references.pmid: 18699939
references.citation: Clin Otolaryngol Allied Sci. 1996 Jun;21(3):278-80
references.pmid: 8818503
references.citation: Curr Allergy Asthma Rep. 2004 Nov;4(6):439-46
references.pmid: 15462709
references.citation: Eur Respir J Suppl. 1993 Mar;16:1-100
references.pmid: 8499052
references.citation: Eur Respir J. 2000 Jul;16(1):44-9
references.pmid: 10933083