Asthma aspirin-sensitive

Aspirin sensitive asthma, affecting about 10% of all asthmatics, is a nonallergic response to aspirin and other agents that inhibit cyclooxygenase-1. Mechanistically, the most likely reasons are lack of bronchoprotective prostaglandin E2 and shunting of arachidonic acid into the leukotriene pathway. 

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... 

Three years after introduction of aspirin into therapy, Hirschberg in Poznan, now in Poland, described the first case of a transient, acute angioedema/urticaria, occurring shortly after ingestion of aspirin. Reports of anaphylactic reactions to aspirin soon followed. The other major type of adverse reaction, acute bronchospasm, was described in the second decade of the 20th century. In 1920, Van der Veer reported the first death due to aspirin. The association of aspirin sensitivity, asthma and nasal polyps was first recorded by Widal in 1922. This clinical entity, later named the aspirin triad was popularized in 1968 by Samter and Beers [3], who presented a... 

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... 

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. 

Preexisting asthma About 10% of patients with asthma may have aspirin-sensitive asthma. Because cross reactivity, including bronchospasm, between aspirin and other NSAIDs has been reported in such aspirin-sensitive patients, do not administer... 

Szczeklik A, Gryglewski RJ, Czerniawska-Mysik G. Participation of prostaglandins in pathogenesis of aspirin-sensitive asthma. Naunyn Schmiedebergs Arch Pharmacol 1977 297(Suppl 1) S99-110. 

Since the registration of Accolate, Zyflo, and Singulair (Table 5.2), most clinical studies have centered on the effects of these agents cxi inflammatory processes. The clinical trials that formed the basis for their approval demonstrated that these agents are safe and effective, and subsequent studies have also borne this out (251,252). These agents are especially effective in aspirin-sensitive asthma and exercise-induced asthma. They are also effective in treating the upper airway responses to IgE-... 

Lee TH. Mechanism of bronchospasm in aspirin-sensitive asthma. Am Rev Respir Dis 1993 148 1442-1443. 

Woessner KM, Simon RA, Stevenson DD. The safety of celecoxib in patients with aspirin-sensitive asthma. Arthritis Rhematism. 2002 46 2201-2206. 

Other toxic effects of NSAIDs include hypersensitivity reactions, rash, and central nervous system complaints of drowsiness, dizziness, headaches, depression, confusion, and tinnitus. Although NSAIDs are generally avoided in patients with asthma who are aspirin-intolerant, studies indicate that celecoxib and rofecoxib are well tolerated in aspirin-sensitive asthma, providing a viable option for these patients. Celecoxib and valdecoxib are sulfonamides and are thus contraindicated for those with sulfa allergies. 

Martin-Garcia C, Hinjosa M, Berges P, et al. Safety of cyclooxygenase-2 inhibitor in patients with aspirin-sensitive asthma. Chest 2002 121 1812-1817. 

Gryglewski RJ, Szczeklik A, Ni nkowska E (1977) Aspirin-sensitive asthma its relationship to inhibition of prostaglandin biosynthesis. NATO Adv Study Inst Ser A Life Sci 13 191-203... 

Szczeklik A, Gryglewski RJ, Czemiawska-Mysik G, Pieton R (1977 b) Asthmatic attacks induced in aspirin-sensitive patients by diclofenac and naproxen. Br Med J 2 231-232 Szczeklik A, Gryglewski RJ, Olszewski E, Dembihska-Kiec A, Czemiawska-Mysik G (1977 c) Aspirin-sensitive asthma the effect of aspirin on the release of prostaglandins from nasal polyps. Pharmacol Res Commun 9 415-425... 

While the use of coxibs as an alternative to other NSAIDs has been suggested for patients with aspirin-induced asthma, there have been case reports of asthmatic reactions to coxibs in patients with aspirin-sensitive asthma [22, 23 ] so caution is necessary. 

Koschei D, Cardoso C, Leucht V, Hoffken G. Asthmatic reaction induced by Etoricoxib in a patient with aspirin-sensitive asthma. Allergy 2008 63(8) 1093-4. 

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