Aspirin asthma with

Hypersensitivity to amide-type local anesthetics, Adams-Stoke syndrome, supraventricular arrhythmias, Wolf-Parkinson-White syndrome. Spinal anesthesia contraindicated in septicemia. Caution Dosage should be reduced for elderly, debilitated, acutely ill safety in children has not been established. Severe renal/hepatic disease, hypovolemia, CHF, shock, heart block, marked hypoxia, severe respiratory depression, bradycardia, incomplete heart block. Anesthetic solutions containing epinephrine should be used with caution in peripheral or hypertensive vascular disease and during or following potent general anesthesia. Sulfite sensitivity or asthma for some local and topical anesthetic preparations. Tartrazine or aspirin sensitivity with some topical preparations. Anxiety, insomnia, apprehension, blurred vision, loss of hearing acuity, and nausea CNS depression, convulsion and respiratory depression... 

Consequently, Zyflo was thoroughly evaluated in a number of clinical trials for effects on models of asthma and in the treatment of chronic asthma. Challenge models of asthma with a variety of stimuli (allergen, exercise, cold dry air, or aspirin) were successful. Results in aspirin-induced asthma were dramatically effective, indicating that leukotrienes are the primary mediators of this response. Zyflo also shows remarkable anti-inflammatory effects, as predicted from animal studies (137). Eosinophil influx and albumin leakage were reduced and the urinary increase in LTE, was blocked (86%)(141,142). 

Matthews KP, Lowell RG, Sheldon JM (1950) The problem of aspirin allergy with a report on skin testing with salicylate containing human sera J Lab Clin Med 36 416-419 McDonald JR, Mathison DA, Stevenson DD (1972) Aspirin intolerance in asthma. J Allergy Clin Immunol 50 198-207... 

Starting with a population of more than 100 patients suspected of aspirin intolerance and suffering from asthma with or without nasal polyposis, Sainte-Laudy in Paris employed the clinical histories, skin tests, IgE determinations, and BAT to find nine cases involving an IgE antibody-dependent mechanism. For the IgE assay, aspirin-lysine was mixed with epoxy (bis-oxirane)-activated Sepharose (Sect. 4.3.1) to form the aspirin solid phase. 

There are few definitive data to substantiate the efficacy of LTRA therapy in refractory asthma, except for patients with aspirin-sensitive asthma. This is a fairly uncommon form of asthma that occurs generally in adults who often have no prior (i.e., childhood) history of asthma or atopy, may have nasal polyposis, and who often are dependent upon oral corticosteroids for control of their asthma. This syndrome is not specific to aspirin but is provoked by any inhibitors of the cycloxygenase-1 (COX-1) pathway. These patients have been shown to have a genetic defect that causes... 

The term refers to a distinct clinical syndrome characterized by aggressive and continuous inflammatory disease of the airways with chronic eosinophilic rhinosinus-itis, asthma and often nasal polyposis [6-8]. Aspirin and other NSAIDs that inhibit COX-1 exacerbate the condition, precipitating violent asthmatics attacks. This is a hallmark of the syndrome. The prevalence of aspirin hypersensitivity in the general population ranges from 0.6 to 2.5%, but is much more frequent in adult asthmatic subjects where it reaches 10-15%, although it is often underdiagnosed. 

Once diagnosed, patients with AlA should avoid aspirin and any other NSAIDs strongly inhibiting COX-1 their education is of utmost importance. They should receive a list of contraindicated and well-tolerated analgesics (table 2). Even topical administration (intravascular or by iontophoresis) of a NSAID may cause an asthma attack and should be avoided. 

In general, treatment of the asthma underlying NSAlDs sensitivity should follow standard asthma guidelines. This type of asthma is often severe and frequently high doses of inhaled corticosteroids and daily doses of oral corticosteroids are necessary. A special treatment option is a chronic desensitization to aspirin [8]. Desensitization and aspirin maintenance is routinely used in some centers for treatment of chronic rhinusinusitis with nasal polyposis. It is the only available procedure which allows AIA patients with ischemic heart disease to use aspirin. During the state of desensitization to aspirin, not only aspirin but almost all strong NSAIDs are tolerated, so desensitization and NSAID maintenance could be used for treatment of rheumatic disease or chronic pain syndromes. 

Genetic factors cannot explain the recent rapid rise in asthma prevalence. Asthma appears to require both genetic predisposition and environmental exposure. Many patients with occupational asthma develop the disease late in life upon exposure to specific allergens in the workplace. Environmental influences in utero or in infancy may contribute to the development of asthma. Maternal smoking during pregnancy or exposure to secondhand smoke after birth increases the risk of childhood asthma.3 Adult-onset asthma is not uncommon and may be related to atopy, nasal polyps, aspirin sensitivity, occupational exposure, or a recurrence of childhood asthma. 

Acute and chronic sinusitis can also aggravate asthma, and antibiotic therapy of sinusitis may improve asthma symptoms.3 Nasal polyps are associated with aspirin-sensitive asthma, and adult patients with nasal polyps should be counseled against using non-steroidal anti-inflammatory medications.1,3... 

COX-2 inhibitors such as celecoxib are associated with adverse effects such as nephrotoxicity and a potential increased risk of myocardial infarction (see Chaps. 55 and 15 for additional information). Combination of COX-2 inhibitors with alcohol may increase GI adverse effects. All NSAIDs should be used with caution in patients with aspirin-induced asthma.31... 

Application of topical salicylates can lead to systemic effects, especially if the product is applied liberally. Repeated application and occlusion with a wrap or bandage also can increase systemic concentrations.41 Salicylate-containing counterirritants should be used with caution in patients in whom systemic salicylates are contraindicated, such as patients with severe asthma or aspirin allergy.42 Topical salicylates have been reported to increase prothrombin time in patients on warfarin and should be used with caution in patients on oral anticoagulants.43... 

Sanak M, Pierzchalska M, Bazan-Socha S, Szczeklik A. Enhanced expression of the leukotriene C(4) synthase due to overactive transcription of an allelic variant associated with aspirin-intolerant asthma. Am J Respir Cell Mol Biol 2000 23 290-296. 

Pierzchalska, M., Szabo, Z., Sanak, M., Soja, J., and Szczekhk, A. (2003) Deficient prostaglandin E-2 production by bronchial fibroblasts of asthmatic patients, with special reference to aspirin-induced asthma. J. Allergy Clin. Immunol. Ill, 1041-1048. 

Kim SH, Oh JM, Kim YS, et al. (2006) Cysteinyl leukotriene receptor 1 promoter polymorphism is associated with aspirin-intolerant asthma in males. Clin Exp Allergy. 36, 433-439. 

Kim SH, Choi JH, Holloway JW, et al. (2005) Leukotriene-related gene polymorphisms in patients with aspirin-intolerant urticaria and aspirin-intolerant asthma differing contributions of ALOX5 polymorphism in Korean population. J Korean Med Sci. 20, 926-931. 

Kawagishi Y, Mita H, Taniguchi M, et al. (2002) Leukotriene C4 synthase promoter polymorphism in Japanese patients with aspirin-induced asthma. J Allergy Clin Immunol. 109,936-942. 

Van SR, Stevenson DD, Baldasaro M, et al. (2000) 5 Flanking region polymorphism of the gene encoding leukotriene C4 synthase does not correlate with the aspirin-intolerant asthma phenotype in the United States. J Allergy Clin Immunol. 106(1 pt. 1), 72-76. 

Hypersensitivity to dipyridamole, aspirin, or any of the other product components. Allergy Aspirin is contraindicated in patients with a known allergy to NSAIDs and in patients with asthma, rhinitis, and nasal polyps. Aspirin may cause severe urticaria, angioedema, or bronchospasms (asthma). 

Asthma (zoledronic acid) While not observed in clinical trials with zoledronic acid, administration of other bisphosphonates has been associated with bronchoconstriction in aspirin-sensitive asthmatic patients. Use zoledronic acid with caution in patients with aspirin-sensitive asthma. 

Hypersensitivity to salicylates or nonsteroidal anti-inflammatory drugs (NSAIDs). Use extreme caution in patients with history of adverse reactions to salicylates. Cross-sensitivity may exist between aspirin and other NSAIDs that inhibit prostaglandin synthesis, and aspirin, and tartrazine. Aspirin cross-sensitivity does not appear to occur with sodium salicylate, salicylamide, or choline salicylate. Aspirin hypersensitivity is more prevalent in those with asthma, nasal polyposis, chronic urticaria. 

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