Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease

Elina Jerschow, Matthew L. Edin, Yuling Chi, Beth Hurst, Waleed M. Abuzeid, Nadeem A. Akbar, Marc Gibber, Marvin P. Fried, Weiguo Han, Teresa Pelletier, Zhen Ren, Taha Keskin, Gigia Roizen, Fred B. Lih, Artiom Gruzdev, J. Alyce Bradbury, Victor Schuster, Simon Spivack, David Rosenstreich, Darryl C. Zeldin

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Background: Nasal polyps influence the burden of aspirin-exacerbated respiratory disease (AERD) by contributing to eicosanoid production. AERD is diagnosed through graded aspirin challenges. It is not known how sinus surgery affects aspirin challenge outcomes. Objective: To investigate the effects of endoscopic sinus surgery (ESS) on aspirin-induced reaction severity and on the levels of eicosanoids associated with these reactions. Methods: Twenty-eight patients with AERD were challenged with aspirin before and 3 to 4 weeks after ESS. Respiratory parameters and plasma and urine levels of eicosanoids were compared before and after challenges. Results: Before ESS, AERD diagnosis was confirmed in all study patients by aspirin challenges that resulted in hypersensitivity reactions. After ESS, reactions to aspirin were less severe in all patients and 12 of 28 patients (43%, P < .001) had no detectable reaction. A lack of clinical reaction to aspirin was associated with lower peripheral blood eosinophilia (0.1 K/μL [interquartile range (IQR) 0.1-0.3] vs 0.4 K/μL [IQR 0.2-0.8]; P = .006), lower urinary leukotriene E 4 levels after aspirin challenge (98 pg/mg creatinine [IQR 61-239] vs 459 pg/mg creatinine [IQR 141-1344]; P = .02), and lower plasma prostaglandin D 2 to prostaglandin E 2 ratio (0 [±0] vs 0.43 [±0.2]; P = .03), compared with those who reacted. Conclusions: Sinus surgery results in decreased aspirin sensitivity and a decrease in several plasma and urine eicosanoid levels in patients with AERD. Diagnostic aspirin challenges should be offered to patients with suspected AERD before ESS to increase diagnostic accuracy. Patients with established AERD could undergo aspirin desensitizations after ESS as the severity of their aspirin-induced hypersensitivity reactions lessens.

Original languageEnglish
Pages (from-to)1580-1588
Number of pages9
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume7
Issue number5
DOIs
StatePublished - May 1 2019

Keywords

  • Aspirin challenges
  • Aspirin-exacerbated respiratory disease
  • Eicosanoids
  • Endoscopic sinus surgery
  • Eosinophils
  • Nasal polyps

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    Jerschow, E., Edin, M. L., Chi, Y., Hurst, B., Abuzeid, W. M., Akbar, N. A., Gibber, M., Fried, M. P., Han, W., Pelletier, T., Ren, Z., Keskin, T., Roizen, G., Lih, F. B., Gruzdev, A., Bradbury, J. A., Schuster, V., Spivack, S., Rosenstreich, D., & Zeldin, D. C. (2019). Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease. Journal of Allergy and Clinical Immunology: In Practice, 7(5), 1580-1588. https://doi.org/10.1016/j.jaip.2018.12.014