title: A novel treatment adjunct for aspirin exacerbated respiratory disease: the low-salicylate diet: a multicenter randomized control crossover trial.
abstract: BACKGROUND
  Aspirin-exacerbated respiratory disease (AERD) is a clinical triad consisting of aspirin/acetylsalicylic acid (ASA) sensitivity, bronchial asthma, and nasal polyposis. Although respiratory reactions following ingestion of ASA and other nonsteroidal anti-inflammatory drugs (NSAIDs) are considered a hallmark of the condition, respiratory inflammation persists despite patients' avoidance of NSAIDs. Treatment of this condition remains challenging and includes both medical and surgical options.
  
  
  METHODS
  A prospective crossover single-blind multicenter study involving 4 tertiary rhinology care centers (n = 30) was conducted in which patients were randomized to start with either 6 weeks of a regular diet or 6 weeks of a low-salicylate diet and then crossed-over for a total study duration of 12 weeks. Patients were evaluated at baseline, 6 weeks (at crossover) and 12 weeks using subjective measures (22-item Sino-Nasal Outcome Test-22 [SNOT-22], Nasal Sinus Symptom Scale [NSSS], and 7-item Asthma Control Questionnaire [ACQ-7]) and objective outcome instruments (Perioperative Sinus Evaluation [POSE] and Lund-Kennedy Endoscopic Score [LKES]).
  
  
  RESULTS
  Data was analyzed for 30 patients. Wilcoxon rank sum tests determined that patients had improvement in their median difference in scores, which were all statistically significant, when they followed the low-salicylate diet compared to their regular diet: SNOT-22: 15 (95% confidence interval [CI], 10 to 23.25), p < 0.001; NSSS: 3 (95% CI, 1.75 to 4), p < 0.001; ACQ-7: 4.5 (95% CI, 1.5 to 8.5), p < 0.001; POSE 6 (95% CI, 2.5 to 10), p < 0.001; and LKES: 2.5 (95% CI, 1.5 to 4), p < 0.001).
  
  
  CONCLUSIONS
  The low-salicylate diet may offer a novel treatment adjunct to the current management of AERD. Clinically and statistically significant improvements on both subjective and objective outcome measures were noted for the upper and lower respiratory tracts.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery McMaster University, Hamilton, Canada.
authors.forename: Doron D
authors.initials: DD
authors.lastname: Sommer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Western University, London, Canada.
authors.forename: Leigh J
authors.initials: LJ
authors.lastname: Sowerby
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.
authors.forename: John M
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, Canada.
authors.forename: Arif
authors.initials: A
authors.lastname: Janjua
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Witterick
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Monteiro
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery McMaster University, Hamilton, Canada.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gupta
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Au
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery McMaster University, Hamilton, Canada.|Department of Otolaryngology-Head and Neck Surgery, Cambridge Memorial Hospital, Cambridge, Canada.
authors.forename: Smriti
authors.initials: S
authors.lastname: Nayan
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects*; D055963:Asthma, Aspirin-Induced / Q000178:diet therapy*; D018592:Cross-Over Studies; D004035:Diet Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000139:chemically induced / Q000178:diet therapy*; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
keywords: aspirin exacerbated respiratory disease; asthma; low-salicylate diet; nasal polyps; salicylates; sinusitis