Aspirin-induced asthma

Aspirin-induced asthma has an onset of 30 minutes to 3 hours after ingestion. Affected individuals are cross-sensitive to all non-steroidal anti-inflammatory drugs (NSAIDs). Paracetamol is seldom associated with cross-sensitivity in patients with aspirin-induced asthma. Aspirin-induced asthma is believed to involve inhibition of COX-1. Patients should be provided with information on which drugs these are. 

Jenkins C, Costello J, Hodge L Systematic review of prevalence of aspirin-induced asthma and its implications for clinical practice. BMJ 2004 328 434-437. Baldassarre S, Schandene L, Choufani G, Michils A Asthma attacks induced by low doses of celecoxib, aspirin and acetaminophen. J Allergy Clin Immunol 2006 117 215-217. 

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... 

Tolerance of Antiinflammatory and Analgesic Drugs in Aspirin-Induced Asthma... 

Obase, Y., Shimoda, T., Tomari, S., et al. (2001) Effects of pranlukast on aspirin-induced bronchoconstiiction differences in chemical mediators between aspirin-intolerant and tolerant asthmatic patients. Ann. Allergy. Asthma. Immunol. 87, 74-79. 

Antczak, A., Montuschi, P., Kharitonov, S., Gorski, P., and Barnes, P. J. (2002) Increased exhaled cysteinyl-leukotrienes and 8-isoprostane in aspirin-induced asthma. Am. J. Respir. Crit. Care Med. 166, 301-306. 

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. 

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. 

Sanak M, Simon HU, Szczeklik A. (1997) Leukotriene C4 synthase promoter polymorphism and risk of aspirin-induced asthma. Lancet. 350, 1599-1600. 

Montelukast, zafirlukast Block leukotriene D4 receptors Block airway response to exercise and antigen challenge Prophylaxis of asthma, especially in children and in aspirin-induced asthma Oral duration hours Toxicity Minimal... 

Hamad AM, Sutcliffe AM and Knox AJ (2004) Aspirin-induced asthma clinical aspects, pathogenesis and management. Drugs 64 2417- 2432. 

Jenkins C, Costello J and Hodge L (2004) Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. British Medical Journal 328 434. 

Aspirin hypersensitivity is relatively common in adults (about 20%). Estimates of the prevalence of aspirin-induced asthma vary from 3.3 to 44% in different reports (SEDA-5,169), although it is often only demonstrable by challenge tests with spirometry, and only 4% have problems in practice. Patients with existing asthma and nasal polyps or chronic urticaria have a greater frequency of hypersensitivity (76), and women appear to be more susceptible than men, perhaps particularly during the childbearing period of life (77). Acute intolerance to aspirin can develop even in patients who have taken the drug for some years without problems. 

Habbab MA, Szwed SA, Haft JI. Is coronary arterial spasm part of the aspirin-induced asthma syndrome Chest 1986 90(l) 141-3. 

Szczeklik A. The cyclooxygenase theory of aspirin-induced asthma. Eur Respir J 1990 3(5) 588-93. 

Szczeklik A. Aspirin-induced asthma pathogenesis and clinical presentation. Allergy Proc 1992 13(4) 163-73. 

Most people tolerate aspirin well, but not patients with asthma, of whom there is a subgroup in whom aspirin precipitates asthmatic attacks (61,62). This is a distinct clinical syndrome, called aspirin-induced asthma, which affects about 10% of adults with asthma (63). Aspirin-induced asthma is usually accompanied by naso-ocular symptoms and can be triggered not only by aspirin, but by several NSAIDs, a fact that makes immunological cross-reactivity most unlikely. The propensity of an NSAID to precipitate an attack of asthma is probably related to inhibition of COX (63). There is evidence that potent inhibitors of COX-1 (such as ibuprofen, indometacin, and naproxen) are more likely to precipitate bronchoconstriction than NSAIDs that inhibit COX-2 preferentially (such as meloxicam and nime-sulide) (64,65). A widely accepted hjrpothesis is that in patients with asthma and aspirin intolerance, NSAJD-induced COX inhibition results in increased products from the 5-lipoxygenase pathway, the leukotrienes, which are both potent bronchoconstrictors and also inducers of... 

The hypothesis that in aspirin-induced asthma the attacks are triggered by inhibition of COX-1 and not COX-2 has been tested in three small studies, two of which were double-blind and placebo-controlled (66-68). In the first stndy (66) 12 patients with aspirin-induced asthma were challenged with increasing doses of rofe-coxib (1.25-25 mg/day for 5 days) no patients had any adverse symptoms, and biochemical markers that reflect intolerance to aspirin in asthma (nrinary lenkotriene E4 and 9a-lip-PGF-2) were nnchanged. 

SzczekUk A, Nizankowska E, Duplaga M. Natural history of aspirin-induced asthma. AIANE Investigators. European Network on Aspirin-Induced Asthma. Eur Respir J 2000 16(3) 432-6. 

SzczekUk A, Stevenson DD. Aspirin-induced asthma advances in pathogenesis and management. J Allergy Clin Immunol 1999 104(1) 5-13. 

SzczekUk A, Nizankowska E, Bochenek G, Nagraba K, Mejza F, Swierczynska M. Safety of a specific COX-2 inhibitor in aspirin-induced asthma. Clin Exp Allergy 2001 31(2) 219-25. 

Kawane H. Aspirin-induced asthma and artificial flavors. Chest 1994 106(2) 654-5. 

Kawane H. Menthol and aspirin-induced asthma. Respir Med 1996 90(4) 247. 

Szczekhk A, Czerniawska-Mysik G, Nizankowska E. Sulfinpyrazone and aspirin-induced asthma. N Engl J Med 1980 303(12) 702-3. 

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). 

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