Habib Rizk1. 1. Department of Otolaryngology/Head and Neck Surgery, Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon. habib.rizk@usj.edu.lb
Abstract
PURPOSE OF REVIEW: This review is set to revisit the pathogenesis of aspirin-exacerbated respiratory disease (AERD), the diagnostic method used, and finally the real impact of aspirin desensitization on chronic sinusitis with nasal polyposis (CRSwNP) in aspirin intolerant patients. RECENT FINDINGS: In AERD, increased baseline production of cysteinyl-leukotriene (Cys-LT) is associated with upregulation of Cys-LT receptors on nasal inflammatory cells. This is further aggravated by inhibition of cyclooxygenase-1 by aspirin and other NSAIDs. New-found genetic markers need further study. Oral aspirin challenge is still the gold standard of diagnosis and can be safely conducted in a specialized outpatient clinic. Oral and endonasal aspirin desensitization show positive impact on CRSwNP course with decreased polyp recurrence, decreased number of hospitalizations, and decreased need for corticosteroids. Modulation of arachidonic acid metabolism and inhibition of intracellular biochemical pathways in key inflammatory cells involving anti-inflammatory cytokines interleukin (IL)-4 and IL-13 explain the clinical outcomes. SUMMARY: Future studies should focus on establishing the lowest possible dose to maintain disease under check, allowing more widespread use of this underutilized and underrecognized treatment modality.
PURPOSE OF REVIEW: This review is set to revisit the pathogenesis of aspirin-exacerbated respiratory disease (AERD), the diagnostic method used, and finally the real impact of aspirin desensitization on chronic sinusitis with nasal polyposis (CRSwNP) in aspirin intolerant patients. RECENT FINDINGS: In AERD, increased baseline production of cysteinyl-leukotriene (Cys-LT) is associated with upregulation of Cys-LT receptors on nasal inflammatory cells. This is further aggravated by inhibition of cyclooxygenase-1 by aspirin and other NSAIDs. New-found genetic markers need further study. Oral aspirin challenge is still the gold standard of diagnosis and can be safely conducted in a specialized outpatient clinic. Oral and endonasal aspirin desensitization show positive impact on CRSwNP course with decreased polyp recurrence, decreased number of hospitalizations, and decreased need for corticosteroids. Modulation of arachidonic acid metabolism and inhibition of intracellular biochemical pathways in key inflammatory cells involving anti-inflammatory cytokines interleukin (IL)-4 and IL-13 explain the clinical outcomes. SUMMARY: Future studies should focus on establishing the lowest possible dose to maintain disease under check, allowing more widespread use of this underutilized and underrecognized treatment modality.