49 Salsalate cross sensitivity in aspirin-sensitive asthmatics

Curr Allergy Asthma Rep

2009

NSAIDs-including aspirin (ASA)-that inhibit cyclooxygenase (COX)-1 induce nonallergic hypersensitivity reactions consisting of attacks of rhinitis and asthma. Such reactions occur exclusively in a subset of asthmatic patients who also have underlying nasal polyps and chronic hyperplastic eosinophilic sinusitis. We now refer to their underlying inflammatory disease of the entire respiratory tract as aspirin-exacerbated respiratory disease. This review focuses on descriptions of these patients; methods available to diagnose ASA-exacerbated respiratory disease; the unique ability of all NSAIDs that inhibit COX-1 to cross-react with ASA; lack of cross-reactivity with selective COX-2 inhibitors; an update on pathogenesis; and current thoughts about treatment, including ASA desensitization and daily ingestion of ASA itself.

Section: Partial Cross-reactivity With Poor Inhibitors Of Cox-1mentioning

confidence: 95%

Aspirin sensitivity and desensitization for asthma and sinusitis

Curr Allergy Asthma Rep

2009

“…However, at high doses, both can induce mild respiratory reactions in patients with AERD. Most patients with AERD can safely tolerate up to 500 mg of acetaminophen, but 28% experienced mild respiratory reactions to 1000 mg of acetaminophen, and another 6% reacted when doses were increased to 1500 mg. 32 Patients with AERD can take salsalate in doses of less than 2000 mg. 33 However, when 2000 mg was given to patients with AERD, mild respiratory reactions occurred in 10% of patients undergoing oral challenges with salsalate. When reactions are elicited at higher doses of acetaminophen and salsalate, they tend to be milder than those observed with the older NSAIDs.…”

Section: Respiratory Reactions To Aspirin and Nsaidsmentioning

confidence: 99%

Clinical and pathologic perspectives on aspirin sensitivity and asthma

Journal of Allergy and Clinical Immunology

Szczeklik

2006

291

258

Aspirin and other nonsteroidal anti-inflammatory drugs that inhibit COX-1 induce unique nonallergic reactions, consisting of attacks of rhinitis and asthma. These hypersensitivity reactions occur in a subset of asthmatic subjects, thus identifying them as having this exclusive clinical presentation. We refer to these patients as having aspirin-exacerbated respiratory disease, a disease process that produces devastating eosinophilic inflammation of both the upper and lower respiratory tracts. This review focuses on a description of patients with aspirin-exacerbated respiratory disease, methods available to diagnose their condition, the unique ability of all nonsteroidal anti-inflammatory drugs that inhibit COX-1 to cross-react with aspirin, an update on pathogenesis, and current thoughts about treatment.

“…Salsalate can be given safely in AERD patients in doses below 2000 mg. However, when 2000 mg was given to patients with AERD, mild respiratory reactions occurred [33]. When reactions are elicited at these higher doses, they tend to be milder than those seen with the older NSAIDs and ASA.…”

Section: Partial Cross-reactivity With Poor Inhibitors Of Cox-1mentioning

confidence: 87%

Role of aspirin and other nonsteroidal anti-inflammatory drugs in aspirin-exacerbated respiratory disease

Lee

Expert Review of Clinical Immunology

2006

Aspirin and other nonsteroidal anti-inflammatory drugs that inhibit cyclooxygenase-1 participate in unique pseudoallergic reactions, in which biochemical inhibitions rather than immunoglobulin E antibody direct the cascade of mediators and ultimate reactions. The settings in which these reactions occur, the contrasts with true immunoglobulin E reactions to these same drugs, and the manner in which diagnosis and treatment can be undertaken form the basis for this review. A discussion of cyclooxygenase-2 inhibitors and their inability to participate in these pseudoallergic reactions is also included. Finally, strategies for desensitization to aspirin and the nonsteroidal anti-inflammatory drugs that inhibit cyclo-oxygenase 1 will be detailed.