Alcohol‐induced respiratory symptoms improve after aspirin desensitization in patients with aspirin‐exacerbated respiratory disease

Glicksman, Jordan T.; Parasher, Arjun K.; Doghramji, Laurel; Brauer, David Lawrence; Waldram, Jeremy D.; Walters, Kristen; Bulva, Jeff; Palmer, James N.; Adappa, Nithin D.; White, Andrew A.; Bosso, John V.

doi:10.1002/alr.22168

Cited by 23 publications

(36 citation statements)

References 15 publications

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“…Consistent with multiple single‐arm observational studies (which some might classify as case‐series in design) reporting a qualitative benefit of aspirin in AERD, we quantified these to be a mean MD 10.27 better in SNOT‐22 QoL (RR 2.00 [95% CI, 1.31 to 3.06]; absolute risk (AR) 48% [95% CI, 31% to 73%]; number needed to treat [NNT] 5 [95% CI, 3 to 14]), and MD 2.56 better in AAO nasal symptoms (RR 2.20 [95% CI, 1.55 to 2.73]; AR 66% [95% CI, 47% to 82%]; NNT 3 [95% CI, 2 to 7]). Additional reported benefits of aspirin desensitization include reduced nasal polyp recurrence, improved olfaction, improved alcohol tolerance, and decreased use of intranasal and oral corticosteroids . It is important to note that these findings were from long‐term investigations up to 6 years of follow‐up.…”

Section: Discussionmentioning

confidence: 87%

Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis

Chu

Lee

et al. 2019

Int Forum Allergy Rhinol

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Background: Aspirin desensitization is increasingly recommended for the treatment of aspirin-exacerbated respiratory disease (AERD). The objective of this study is to systematically review the efficacy and safety of aspirin desensitization in patients with AERD. Methods:We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and World Health Organization (WHO) International Clinical Trials Registry Platform from inception to January 5, 2019. We included randomized trials and comparative observational studies in any language. Data extraction and risk of bias assessment were performed in duplicate independently. Results: Five randomized controlled trials (RCTs) enrolled 233 patients with AERD. Compared to placebo, aspirin desensitization (mean daily dose 800 mg) improved quality of life (risk ratio [RR] 2.00; 95% confidence interval [CI], 1.31 to 3.06; heterogeneity measure [I 2 ] = 0%; risk difference [RD] +24%; 22-item Sino-Nasal Outcome Test [SNOT-22] scale [0 to 110, higher worse]; mean difference [MD] −10.27 [95% CI, −6.39 to −14.15]; moderate-certainty); and respiratory symptoms (RR 2.20 [95% CI, 1.55 to 2.73], I 2 = 34%, RD +36%; American Academy of Otolaryngology (AAO) scale [0 to 20, higher worse]; MD −2.56 [95% CI,−1.12 to −3.92]; high-certainty). Aspirin desensitization increasedadverse events severe enough to cause treatment discontinuation (major bleeding, gastritis, asthma exacerbation, or rash causing drug discontinuation, RR 4.39 [95% CI, 1.43 to 13.50], I 2 = 0%, RD +11%, moderate-certainty), and gastritis (RR 3.84 [95% CI, 1.12 to 13.19], I 2 = 0%, RD +9%, lowcertainty). Findings were robust to sensitivity analyses. Two available observational studies were not informative because they lacked adjustment for confounders and/or contemporaneous controls. Conclusion:In patients with AERD, moderate-certainty and high-certainty evidence shows that aspirin desensitization meaningfully reduces symptoms of rhinosinusitis and improves quality of life, but results in a significant increase in adverse events. C 2019 ARS-AAOA, LLC.

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Section: Discussionmentioning

confidence: 87%

Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis

Chu

Lee

et al. 2019

Int Forum Allergy Rhinol

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“…[9][10][11] Oral aspirin desensitization (AD) has been shown to be an effective tool for disease control. 3,[10][11][12] More recently, studies have shown that sinus surgery followed by AD and maintenance therapy leads to effective long-term control of sinus disease burden in AERD. 7,13,14 Despite the efficacy of corticosteroids in the treatment of AERD, little is known regarding the impact upon corticosteroid use of surgical treatment of inflammatory burden followed by AD.…”

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confidence: 99%

Complete endoscopic sinus surgery followed by aspirin desensitization is associated with decreased overall corticosteroid use

Bosso

Locke

Kuan

et al. 2020

Int Forum Allergy Rhinol

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Background Aspirin‐exacerbated respiratory disease (AERD) is an aggressive respiratory tract inflammatory disorder manifesting as asthma, chronic rhinosinusitis with nasal polyposis, and a respiratory sensitivity to aspirin and nonsteroidal anti‐inflammatory drugs (NSAIDs). Corticosteroids, both systemic and topical/inhaled, are used to treat inflammation of the upper and lower airways. Our objective was to examine the potential impact of complete endoscopic sinus surgery (ESS) and aspirin desensitization (AD) on short‐term and long‐term corticosteroid use. Methods For this pilot study, a retrospective chart review of all patients with AERD who underwent ESS followed by AD was performed. Daily prednisone use, average daily prednisone dose, and inhaled corticosteroid use were analyzed at the following time points: preoperative, postoperative/pre‐AD, and 2 to 3 months, 4 to 6 months, 7 to 12 months, and 13 to 24 months following AD. Results A total of 125 patients underwent ESS followed by AD. Compared to preoperatively, patients who underwent ESS and AD were less likely to be on daily prednisone at all time points and upon long‐term follow‐up (32% preoperatively vs 10% at 13 to 24 months, McNemar's test = 9.00, p = 0.009). Average daily prednisone dose decreased from 10.6 ± 7.9 mg preoperatively to 3.8 ± 2.6 mg at 13 to 24 months following AD (Mann‐Whitney U; W = 122, p = 0.01). Similarly, high‐dose and medium‐dose inhaled corticosteroid use decreased from 18% to 7% and from 36% to 22% respectively (Pearson's chi‐square = 8.06, p = 0.05). Conclusion In our AERD cohort who underwent ESS followed by AD, there was an observed decrease in overall systemic and topical/inhaled corticosteroid use. These findings can have implications for treatment given the potentially hazardous side effects of corticosteroid use.

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“…18 In addition to steroid rinses, postoperative aspirin desensitization further improves outcomes in patient-reported QOL, alcohol tolerance, olfaction, and endoscopy scores, resulting in contemporary revision surgery rates as low as 9% at 30 months. 6,19,20 There is no question that despite all of the above interventions, polyps do recur in some AERD patients, resulting in impaired QOL and worse control of CRS. 21 The advent of biologics promises to revolutionize the treatment of these patients who would otherwise be subjected to chronic systemic steroid use.…”

Section: How To Cite This Article Schlosser Rodney J Aspirin-exacerbamentioning

confidence: 99%

“…Alcohol sensitivity may be present in up to 75% of AERD patients. 1,6 Reports have differed on the association of atopy with AERD, with some authors suggesting there is no increase compared to non-AERD patients, whereas others report atopy rates as high as 82% in AERD patients. 2,7 Two additional clinical factors that are of particular interest to rhinologists are the impact of AERD upon olfaction and the unique distribution of polyps on computed tomography (CT).…”

mentioning

confidence: 99%

Aspirin‐exacerbated respiratory disease: personalized medical and surgical approaches

Schlosser

2020

Int Forum Allergy Rhinol

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Alcohol‐induced respiratory symptoms improve after aspirin desensitization in patients with aspirin‐exacerbated respiratory disease

Abstract: The majority of patients with AERD who experience respiratory symptoms with alcohol consumption describe improvement in this domain following aspirin desensitization.

Cited by 23 publications

References 15 publications

Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis

Benefits and harms of aspirin desensitization for aspirin‐exacerbated respiratory disease: a systematic review and meta‐analysis

Complete endoscopic sinus surgery followed by aspirin desensitization is associated with decreased overall corticosteroid use

Aspirin‐exacerbated respiratory disease: personalized medical and surgical approaches

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