title: Diagnostic Utility of Urinary LTE4 in Asthma, Allergic Rhinitis, Chronic Rhinosinusitis, Nasal Polyps, and Aspirin Sensitivity.
abstract: Urinary leukotriene E4 (LTE4) is a well-validated marker of the cysteinyl leukotriene pathway, and LTE4 elevation has been described in conditions such as asthma, aspirin sensitivity, and chronic rhinosinusitis (CRS). There have been a number of reports investigating the role of spot urine LTE4 to predict aspirin sensitivity; however, variability in urinary LTE4 may affect the accuracy of this approach.
  
  
  
  Here, we explored the utility of 24-hour urinary LTE4 in 5 clinical diagnoses of allergic rhinitis, asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), CRS without nasal polyps, and aspirin sensitivity.
  
  
  
  This was a retrospective review of patients who had 24-hour quantification of urinary LTE4 by a clinically validated liquid chromatography tandem mass spectrometry method and their assigned diagnoses after assessment and clinical care.
  
  
  
  Twenty-four-hour urinary LTE4 elevations were seen in those with asthma and those with CRSwNP but influenced by underlying aspirin sensitivity. Elevation in LTE4 was significant in those with CRSwNP after adjusting for aspirin sensitivity. Allergic rhinitis was not associated with elevated LTE4 excretion. Receiver operator characteristic analysis of 24-hour urinary LTE4 showed that a cutoff value of 166 pg/mg Cr suggested the presence of history of aspirin sensitivity with 89% specificity, whereas a cutoff value of 241 pg/mg Cr discriminated "challenge-confirmed" aspirin-sensitive subjects with 92% specificity.
  
  
  
  Elevated 24-hour excretion of urinary LTE4 is a reliable and simple test to identify aspirin sensitivity in patients with respiratory diagnoses.
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn. Electronic address: Divekar.Rohit@mayo.edu.
authors.forename: Rohit
authors.initials: R
authors.lastname: Divekar
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: John
authors.initials: J
authors.lastname: Hagan
authors.affiliation: Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz.
authors.forename: Matthew
authors.initials: M
authors.lastname: Rank
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Miguel
authors.initials: M
authors.lastname: Park
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Gerald
authors.initials: G
authors.lastname: Volcheck
authors.affiliation: Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minn.
authors.forename: Erin
authors.initials: E
authors.lastname: O'Brien
authors.affiliation: Laboratory Medicine and pathology, Mayo Clinic, Rochester, Minn.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Meeusen
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Kita
authors.affiliation: Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Joseph
authors.initials: J
authors.lastname: Butterfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects; D001249:Asthma / Q000175:diagnosis* / Q000652:urine; D015415:Biomarkers / Q000652:urine; D002908:Chronic Disease; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000652:urine; D005260:Female; D006801:Humans; D017999:Leukotriene E4 / Q000652:urine*; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000175:diagnosis* / Q000652:urine; D012220:Rhinitis / Q000175:diagnosis* / Q000652:urine; D012852:Sinusitis / Q000175:diagnosis* / Q000652:urine; D055815:Young Adult
chemical_list: D015415:Biomarkers; D017999:Leukotriene E4; D001241:Aspirin
keywords: AERD; Aspirin; Diagnostic; LTE4; Leukotriene; Predictive; Rhinosinusitis; Sensitivity; Specificity; Urinary