Aspirin sensitivity

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... 

LTRAs are extremely safe for patient use. However, the present generation of LTRAs is only modestly efficacious. Many patients show no clinically meaningful response, and current recommendations suggest a 1 month trial period to determine if patients will benefit from these drugs. With the exception of aspirin-sensitive asthmatics, there is currently no means for predicting which patients or under what circumstances antileukotrine therapies will be effective. 

Administration of zafirlukast and aspirin increases plasma levels of zafirlukast, When zafirlukast is administered with warfarin, there is an increased effect of the anti coagulant. Administration of zafirlukast and theophylline or erythromycin may result in a decreased level of zafirlukast. Administration of montelukast with other drugs has not revealed any adverse responses. Administration of montelukast with aspirin and NSAIDs is avoided in patients with known aspirin sensitivity. Administration of zileuton with propranolol increases the activity or the propranolol with theophylline increases serum theophylline levels and with warfarin may increase prothrombin time (PT). A prothrombin blood test should be done regularly in the event dosages of warfarin need to be decreased. 

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... 

Szczeklik A, Gryglewski RJ, Czerniawska-Mysik G Relationship of inhibition of prostaglandin biosynthesis by analgesics to asthma attacks in aspirin-sensitive patients. Br Med J 1975 1 67-69. 

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... 

Aspirin desensitization is useful in diseases where low-level antiplatelet action is needed and in the care of patients with aspirin sensitivity and intractable nasal polyps. Lysine aspirin availability in Europe allows desensitization by inhalation at... 

Methyl salicylate 10-60% Analgesic Balm3 BenGay Ultra Strength3 Icy Hot Chill Stick3 Caution in aspirin sensitivity May produce systemic concentrations... 

A very small percentage (5%) of aspirin-sensitive patients read to acetaminophen and phenacetin. 

Corrigan C, Mallett K, Ying S, et al. (2005) Expression of the cysteinyl leukotriene receptors cysLT(l) and cysLT(2) in aspirin-sensitive and aspirin-tolerant chronic rhinosinusitis. J Allergy Clin Immunol. 115, 316-322. 

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. 

Aspirin sensitivity Patients with known aspirin sensitivity should continue avoidance of aspirin and nonsteroidal anti-inflammatory agents while taking montelukast. 

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... 

NSAIDs to patients with this form of aspirin sensitivity, and use the drug with caution in patients with preexisting asthma. 

The arylpropionic acid derivatives are useful for the treatment of rheumatoid arthritis and osteoarthritis, for reduction of mild to moderate pain and fever, and for pain associated with dysmenorrhea. Side effects of the drugs are similar to but less severe than those described for the salicylates. Those who are sensitive to salicylates also may be sensitive to and have adverse reactions when taking ibuprofen and related drugs. Acute hypersensitivity to ibuprofen has been reported in patients with lupus. The hypersensitivity reaction to sulindac can be fatal. The use of sulindac has also been linked to cases of acute pancreatitis. The use of dimethylsulfoxide (DMSO) topically in combination with sulindac has been reported to induce severe neuropathies. The concurrent use of ibuprofen with aspirin reduces the antiinflammatory effects of both drugs. Ibuprofen is contraindicated in patients with aspirin sensitivity leading to bronchiolar constriction and in patients with an-gioedema. As with all NSAIDs, renal and liver function should be normal for adequate clearance of the drugs. 

Use with caution in older patients with Renal impairment, Hepatic impairment, Cardiovascular Disease, CHF, HTN, PUD, History of GI bleeding, GERD, Bleeding and platelet disorders. History of aspirin sensitivity reaction. Also use with caution in patients taking Anticoagulants, Aspirin, and Ant (hypertensive agents. 

Patients with aspirin sensitivity should avoid aspirin and NSAIDs while taking mon-telukast... 

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