title: Clinical benefits of aspirin desensitization in patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease are not related to urinary eicosanoid release and are accompanied with decreased urine creatinine.
abstract: BACKGROUND
  Treatment with acetylsalicylic acid (ASA) after desensitization may be a therapeutic option in patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease (NERD). The mechanisms that lead to improvement in rhinosinusitis and asthma symptoms remain unknown.
  
  
  OBJECTIVE
  To attribute the documented clinical effects of ASA treatment of chronic rhinosinusitis and/or asthma to the release of eicosanoid metabolites in urine.
  
  
  METHODS
  Fourteen patients with NERD were successfully desensitized, and, eventually, eight patients were treated with 650 mg of ASA daily for 3 months. In addition to clinical assessments, nuclear magnetic resonance imaging and smell test were performed before and after treatment with ASA. Venous blood and urine were collected before desensitization and after 1 and 3 months of treatment. The levels of urinary leukotrienes (LT) (cysteinyl LT and LTE4) and tetranor PGDM (metabolite of prostaglandin D2) were measured by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Treatment with ASA after desensitization alleviated symptoms of rhinosinusitis, improved nasal patency (mean, 50% decrease in peak nasal inspiratory flow) and sense of smell (fourfold increase in smell test score) in as early as 4 weeks. Clinical improvements were not accompanied by any change in sinonasal mucosa thickness as assessed with nuclear magnetic resonance. Urinary cysteinyl LTs, LTE4, and prostaglandin D2 metabolite remained relatively stable during ASA treatment and did not correlate with clinical improvements. Desensitization was associated with a progressive decrease of urinary creatinine.
  
  
  CONCLUSIONS
  Clinical improvement in rhinosinusitis and/or asthma after ASA desensitization was not related to concentrations of urinary eicosanoid metabolites. A decrease of urinary creatinine requires further study to determine the renal safety of long-term treatment with ASA after desensitization.
authors.affiliation: Department of Rheumatology, Medical University of Lodz, Poland.
authors.forename: Joanna S
authors.initials: JS
authors.lastname: Makowska
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Olszewska-Ziąber
authors.forename: Barbara
authors.initials: B
authors.lastname: Bieńkiewicz
authors.forename: Anna
authors.initials: A
authors.lastname: Lewandowska-Polak
authors.forename: Marcin
authors.initials: M
authors.lastname: Kurowski
authors.forename: Bartłomiej
authors.initials: B
authors.lastname: Woźniakowski
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Rotkiewicz
authors.forename: Marek L
authors.initials: ML
authors.lastname: Kowalski
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000276:immunology / Q000494:pharmacology / Q000627:therapeutic use*; D001249:Asthma / Q000652:urine; D003401:Creatine / Q000652:urine*; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000628:therapy*; D015777:Eicosanoids / Q000652:urine*; D006801:Humans; D015289:Leukotrienes / Q000652:urine; D015230:Prostaglandin D2 / Q000031:analogs & derivatives / Q000652:urine; D012140:Respiratory Tract Diseases / Q000139:chemically induced / Q000276:immunology / Q000652:urine; D012852:Sinusitis / Q000652:urine
chemical_list: C527346:11,15-dioxo-9-hydroxy-2,3,4,5-tetranorprostan-1,20-dioic acid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015777:Eicosanoids; D015289:Leukotrienes; D003401:Creatine; D001241:Aspirin; D015230:Prostaglandin D2