@article{b5e7b249fadd4424906252f11d678071,
title = "Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease",
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.",
keywords = "Aspirin challenges, Aspirin-exacerbated respiratory disease, Eicosanoids, Endoscopic sinus surgery, Eosinophils, Nasal polyps",
author = "Elina Jerschow and Edin, {Matthew L.} and Yuling Chi and Beth Hurst and Abuzeid, {Waleed M.} and Akbar, {Nadeem A.} and Marc Gibber and Fried, {Marvin P.} and Weiguo Han and Teresa Pelletier and Zhen Ren and Taha Keskin and Gigia Roizen and Lih, {Fred B.} and Artiom Gruzdev and Bradbury, {J. Alyce} and Victor Schuster and Simon Spivack and David Rosenstreich and Zeldin, {Darryl C.}",
note = "Funding Information: This work was supported by CTSA grant number 5KL2TR001071 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Portions of this work were funded by the Stony Wold-Herbert Fund research grant and by Hiram and Jeanne Gray Funding (to EJ) and by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01 ES025034 to DCZ). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.Conflicts of interest: E. Jerschow has research support from Stony-Wold Herbert Fund and Cumberland Pharmaceuticals, Inc. (not relevant to the present study). W. M. Abuzeid is a consultant for Medtronic, Inc. The rest of the authors declare that they have no relevant conflicts of interest. This work was supported by CTSA grant number 5KL2TR001071 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Portions of this work were funded by the Stony Wold-Herbert Fund research grant and by Hiram and Jeanne Gray Funding (to EJ) and by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (Z01 ES025034 to DCZ). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Conflicts of interest: E. Jerschow has research support from Stony-Wold Herbert Fund and Cumberland Pharmaceuticals, Inc. (not relevant to the present study). W. M. Abuzeid is a consultant for Medtronic, Inc. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: This work was supported by CTSA grant number 5KL2TR001071 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Portions of this work were funded by the Stony Wold-Herbert Fund research grant and by Hiram and Jeanne Gray Funding (to EJ) and by the Intramural Research Program of the NIH , National Institute of Environmental Health Sciences (Z01 ES025034 to DCZ). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Publisher Copyright: {\textcopyright} 2018 American Academy of Allergy, Asthma & Immunology",
year = "2019",
month = may,
day = "1",
doi = "10.1016/j.jaip.2018.12.014",
language = "English",
volume = "7",
pages = "1580--1588",
journal = "Journal of Allergy and Clinical Immunology: In Practice",
issn = "2213-2198",
number = "5",
}