No abstract

Aspirin/Nonsteroidal anti-inflammatory drugs -Exacerbated Respiratory Disease (AERD) is characterized by chronic rhinosinusitis with nasal polyps, asthma and reactions to non-steroidal anti-inflammatory drugs (NSAIDs). The present study aimed to describe the clinical and epidemiological profile of patients with AERD, and the clinical response to aspirin therapy after desensitization (ATAD) and treatment with omalizumab. It was an observational study, with a retrospective and descriptive analysis of characteristics of patients selected from those seen at the Allergy and Immunology and Otorhinolaryngology outpatient clinics at HCFMRP-USP. Data were collected through analysis of medical records, attendance at medical appointments or telephone interviews. 75 patients were included, with a mean age of 50 years, and female predominance (69%). Elevated total IgE was found in 67.8% of patients, and eosinophilia in peripheral blood in 55%. Aeroallergen sensitization was observed in 76.5% of patients. The order of onset of clinical conditions in adulthood was nasal symptoms, asthma, nasal polyposis, and hypersensitivity reaction to NSAIDs. Nasal polyps were diagnosed on average on 2.1 occasions. According to the Asthma Control Test (ACT), 49% had wellcontrolled asthma and 51% partially or poorly controlled asthma. Asthma severity by the steps of the Global Initiative for Asthma (GINA) revealed mild asthma in 43%, and moderate and severe asthma in 57% of patients. Reactions to NSAIDs were characterized by respiratory symptoms in 71%, cutaneous symptoms in 5%, and mixed reactions or anaphylaxis in 24% of patients. A diagnosis of hypersensitivity to NSAIDs was made by oral provocation test with aspirin in 14% of the patients, and by an unequivocal clinical history in the remaining patients. More severe ACT was associated with anaphylactic reactions (p = 0.04). 31.7% of patients reported a reaction after drinking alcohol. 40/75 patients underwent ATAD and of these, 47.5% suspended treatment for reasons that included gastrointestinal symptoms, poor adherence, urticaria, surgery, bleeding, anemia and dengue. In patients who maintained ATAD (n = 21) a significant improvement in asthma control was observed (mean ACT 22 and 24 before and after beginning of ATAD, p = 0.02); decrease in the number of sinus attacks per year (average number of attacks per year 4.3 and 1.4, before and after the start of ATAD, p = 0.008); and improvement of sino-nasal symptoms and quality of life, with mean values of the Sino-Nasal Outcome Test SNOT-22 of 61.7 and 23.1 before and after the start of ATAD (p <0.001), respectively. 6/21 patients (29.5%) had recurrence of nasal polyps. Six patients were treated with omalizumab and had a drop in the number of nasal polyps recurrences from 2.5 to 0.5, before and after the start of treatment, respectively. We concluded that our patients with AERD had characteristics similar to those described in the literature, such as age, predominant sex, asthma severity, and a predominance of respiratory reactions to NSAIDs....