Effects of lysine-acetylsalicylate (LAS) treatment in nasal polyposis: two controlled long term prospective follow up studies

Nucera, Eleonora; Schiavino, Domenico; Milani, Alessandro; Ninno, M. Del; Misuraca, Clementina; Buonomo, Alessandro; D’Ambrosio, Claudio; Paludetti, Gaetano; Patriarca, Giampiero

doi:10.1136/thorax.55.suppl_2.s75

Cited by 45 publications

(33 citation statements)

References 19 publications

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“…The group treated with LAS postoperatively had a recurrence rate of 6.9% after 1 year and 65% after 6 years, while controls experienced recurrence in 51.3% at 1 year and 93.5% at 6 years after the operation. Systemic gluco corticoids and nasal LAS resulted in 33% having unchanged polyp size after 3 years compared with 15% in the operated group, but this was not statistically significant [110]. A case-controlled trial of treatment with LAS to one nostril and placebo to the other in 13 patients with bilateral NP resulted in delayed polyp recurrence, and eight patients remained symptomfree at the 15-month observation period, which was significantly better than the results for patients previously treated with steroid for recurrence prevention.…”

Section: Aspirin Desensitizationcontrasting

confidence: 64%

“…There were reductions in hospitalizations and the use of systematic corticosteroids for treatment of asthma [109]. Nucera et al followed three groups of patients with NP (approximately 50% aspirin sensitive): the first with 76 consecutive nasal polypectomy patients who had a topical LAS afterwards; the second group contained 49 patients with 40 mg triamcinolone retard and also further LAS; and the third with 191 control patients who only had undergone polypectomy [110]. The group treated with LAS postoperatively had a recurrence rate of 6.9% after 1 year and 65% after 6 years, while controls experienced recurrence in 51.3% at 1 year and 93.5% at 6 years after the operation.…”

Section: Aspirin Desensitizationmentioning

confidence: 97%

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Controversies in the treatment of chronic rhinosinusitis

Guilemany

Alobid

Mullol

2010

Expert Review of Respiratory Medicine

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Chronic rhinosinusitis (CRS) including nasal polyps is a chronic inflammatory disease involving the mucosa of the nose and one or more paranasal sinuses. Despite differing hypotheses, the cause remains poorly understood. The key issue is the maintaining of ostial patency. CRS with nasal polyps is considered to be a subgroup of CRS. Major symptoms are nasal congestion or blockage, loss of smell, rhinorrhea, post-nasal drip, and facial pain or pressure. CRS is associated with lower airway disease such asthma, chronic obstructive pulmonary disease and bronchiectasis. In CRS with and without nasal polyps, medical treatment, including nasal and oral corticosteroids, is the first therapeutic option. The treatment of CRS still remains an unmet need. Corticosteroids are the mainstay of treatment and are the most effective drugs for treating airway inflammatory diseases such as asthma, allergic rhinitis and CRS. Endoscopic sinus surgery is only recommended when medical treatment fails. After surgery, medical treatment, including nasal and oral corticosteroids, is recommended.

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Section: Aspirin Desensitizationcontrasting

confidence: 64%

Section: Aspirin Desensitizationmentioning

confidence: 97%

Controversies in the treatment of chronic rhinosinusitis

Guilemany

Alobid

Mullol

2010

Expert Review of Respiratory Medicine

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“…4 Intranasal therapy with lysine-aspirin has been reported to be effective in both aspirin-sensitive and aspirin-tolerant nasal polyps. 9,14 -16 Nucera et al 15 showed, in an open study, that the relapse rates of nasal polyps after medical or surgical polypectomy were significantly lower than those for a non-randomised control group, in patients receiving a low (sub-desensitising) dose of lysine-aspirin once weekly. Although we previously attempted to ascertain the effects of desensitising doses of intranasal lysine-aspirin in aspirin-sensitive polyps, there was no evidence of clinical benefit when lysine-aspirin was used alone.…”

Section: Discussionmentioning

confidence: 99%

Intranasal lysine-aspirin administration decreases polyp volume in patients with aspirin-intolerant asthma

Ogata

Darby

2007

J. Laryngol. Otol.

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Introduction: Nasal polyposis associated with aspirin-intolerant asthma tends to be difficult to control, with frequent recurrences. We examined the effect of intranasal lysine-aspirin administration on resistant nasal polyps of asthmatic, aspirin-intolerant patients, when used in addition to routine therapy.Patients and methods: Thirteen patients with asthma and intolerance to aspirin were recruited. All but one had undergone numerous polypectomies and were uncontrolled on standard therapy with intranasal corticosteroids, leukotriene receptor antagonists and nasal douching. Aspirin treatment involved one drop (100 ml) of 30 mg/ml lysine-aspirin solution to each nostril, initially daily, increased every two or three days up to a maximal of 18 drops (54 mg lysine-aspirin) a day. Nasal symptoms, nitric oxide level, nasal inspiratory peak flow rate, peak expiratory flow rate and nasendoscopic grading were assessed prior to therapy and three months later. We also compared the change in endoscopic polyp scores during three months of lysine-aspirin administration with the changes which had occurred during the three months prior to administration (during which time other therapies had been identical).Results: Nasal blockage symptoms tended to decrease; other nasal symptoms were unchanged. Significant changes were seen in nasal inspiratory peak flow rate (103.3 + 18.9 and 140.0 + 16.7 l/ min before and after aspirin, respectively; p ¼ 0.014), but not in peak expiratory flow rate (438.7 + 33.4 and 440.0 + 28.4 l/min before and after aspirin, respectively; p ¼ 0.700). Nasal nitric oxide levels rose significantly (in both sides, p ¼ 0.028). Expired chest nitric oxide levels did not change. Nasal polyp scores on nasendoscopic examination were significantly reduced (right side, p ¼ 0.027; left side, p ¼ 0.018). Compared with the preceding three months, adding intranasal lysine-aspirin application had the effect on decreasing nasal polyp volume (right side, p ¼ 0.031; left side, p ¼ 0.016).Conclusion: This open study suggests that intranasal lysine-aspirin administration reduces nasal polyp volume in aspirin-intolerant patients, without any adverse affect on concomitant asthma. This was a preliminary study and should be followed by a placebo-controlled, double-blind trial.

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“…Berges-Jimeno et al [50] reported that patients with aspirin-sensitive asthma who were treated with 325 mg of aspirin twice daily for 1 year were desensitized to aspirin and demonstrated improved nasal symptoms, reduced rhinosinusitis episodes, and reduced need for systemic corticosteroids. Most studies have concluded that regular oral [51,52] or nasal [53] desensitization improved nasal symptoms and controlled polyp growth rate. These results are in contrast to the recent first controlled clinical trial of intranasal desensitization with low-dose lysine-aspirin, in which an analysis of outcome measures for polyp growth and nasal symptoms failed to demonstrate significant clinical benefits over placebo [54].…”

Section: Patient Education To Avoid Nsaidsmentioning

confidence: 97%

Cyclooxygenases and the pathogenesis of chronic rhinosinusitis and nasal polyposis

Guilemany¹,

Roca‐Ferrer²,

Mullol

2008

Curr Allergy Asthma Rep

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Cyclooxygenase (COX) enzymes catalyze the rate-limiting steps in prostaglandin synthesis. Prostaglandins have an important role in several physiological processes such as maintenance of gastrointestinal integrity and pathological processes such as inflammation and neoplasia. Several mechanisms have been proposed for the development of chronic rhinosinusitis, but the common final pathway seems to be an integrated process involving the mucosal epithelium, matrix, and inflammatory cells and mediators. Upper and lower airway pathologies coexist and share common etiopathogenic mechanisms, and nasal polyposis is often associated with asthma and aspirin sensitivity. The cellular source of COX activity in acute and chronic inflammation, as in chronic rhinosinusitis, is poorly understood. COX theory postulated that inhibition of COX broke down biochemical reactions that lead to the development of asthma attacks. This article focuses on COX in the pathogenesis of chronic rhinosinusitis and nasal polyposis.

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Effects of lysine-acetylsalicylate (LAS) treatment in nasal polyposis: two controlled long term prospective follow up studies

Cited by 45 publications

References 19 publications

Controversies in the treatment of chronic rhinosinusitis

Controversies in the treatment of chronic rhinosinusitis

Intranasal lysine-aspirin administration decreases polyp volume in patients with aspirin-intolerant asthma

Cyclooxygenases and the pathogenesis of chronic rhinosinusitis and nasal polyposis

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