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1. The importance of timely diagnosis of aspirin-exacerbated respiratory disease for patient health and safety

Author

Tanya M. Laidlaw, Kathleen M. Buchheit, Jillian C. Bensko, Erin I. Lewis, and Deborah Gakpo

Subjects
medicine.medical_specialty, NSAID hypersensitivity, RD1-811, Anosmia, Population, Timely diagnosis, Occupational safety and health, Aspirin hypersensitivity, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Aspirin challenge, Aspirin (acetylsalicylic acid, ASA), medicine, Nasal polyps, 030223 otorhinolaryngology, education, Asthma, Aspirin, education.field_of_study, Samter's triad, business.industry, Respiratory disease, medicine.disease, Chronic rhinosinusitis with nasal polyps, Otorhinolaryngology, RF1-547, 030220 oncology & carcinogenesis, NSAID challenge, Surgery, medicine.symptom, business, medicine.drug, Research Paper, Aspirin-exacerbated respiratory disease (AERD)
Abstract

Backgroud Aspirin-exacerbated respiratory disease (AERD) is a difficult-to-treat syndrome where timely diagnosis and initiation of disease-specific therapies are pertinent to improved patient outcomes. Objective To characterize the most common timeline for development of the clinical triad [asthma, nasal polyposis, and reactions to nonsteroidal anti-inflammatory drugs (NSAIDs)], identify barriers to prompt diagnosis of AERD, and describe indications for an aspirin challenge to facilitate accurate diagnosis. Methods Six hundred ninety-seven patients with diagnosed AERD and history of at least one sinus surgery to remove nasal polyps were identified in the Brigham and Women's Hospital AERD registry. Patient reported age at disease onset of asthma, nasal polyposis, and age of first NSAID reaction were obtained from 2013 to 2019 at enrollment. Results Of the 697 patients identified, diagnosis of asthma preceded diagnosis of nasal polyposis and first NSAID reaction, although there was considerable variability between patients. Conclusions Prompt diagnosis of AERD is important for patient and provider education and improved care of this difficult-to-treat population of patients. Consider diagnostic aspirin challenge in patients without historical reactions to NSAIDs who have an otherwise compatible clinical history, specifically in patients who take daily low-dose aspirin, leukotriene modifiers, avoid NSAIDs, or who are severely symptomatic at baseline where it would be difficult to identify an acute worsening of symptoms.

Published
2020

2. A Disease Marker for Aspirin-Induced Chronic Urticaria.

Author

Chia-Wei Hsieh, Jeen-Wei Lee, En-Chih Liao, and Jaw-Ji Tsai

Subjects
PHYSIOLOGICAL effects of aspirin, URTICARIA, SINGLE nucleotide polymorphisms, DRUG allergy, BASOPHILS, GENETICS
Abstract

There are currently no diagnostic methods in vitro for aspirin-induced chronic urticaria (AICU) except for the provocation test in vivo. To identify disease markers for AICU, we investigated the single nucleotide polymorphism (SNP) of the promoter loci of high-affinity IgE receptor (FcεRIa) and CD203c expression level in Chinese patients with AICU. We studied two genotypic and allelic frequencies of rs2427827 (-344C/T) and rs2251746 (-66T/C) gene polymorphisms of FcεRIa in 20 patients with AICU, 52 subjects with airway hypersensitivity without aspirin intolerance, and 50 controls in a Chinese population. The results showed that the frequencies of two SNPs (-344C>T, -66C>T) were similar to the normal controls. The allele frequency of -344CC was significantly higher in the patients with AICU compared to those with airway sensitivity (p = 0.019). We also studied both histamine release and CD203c expression on KU812 cells to assess aspirin-induced basophil activation. We found that the activity of basophil activation of AICU was significantly higher in the patients with AICU compared to those with airway hypersensitivity without aspirin intolerance. The mean fluorescence intensity of the CD203c expression were 122.5 ± 5.2 vs. 103.3 ± 3.3 respectively, (p < 0.05), and the percentages of histamine release were 31.3% ± 7.4% vs. -24.0% ± 17.5%, (p < 0.05) respectively. Although the mean fluorescence intensity of CD203c expression and the percentage of histamine release were significantly up-regulated by aspirin, they were not affected by anti-IgE antibodies. These results suggest that a single SNP of FcεRIa (-344C>T) is less likely to develop AICU and the basophil activation activity in the sera by measuring CD203c expression can be applicable to confirm the diagnosis of AICU. [ABSTRACT FROM AUTHOR]

Published
2014
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