Incidence of aspirin hypersensitivity in patients with chronic rhinosinusitis and diagnostic value of urinary leukotriene E4

Abstract

IntroductIon Chronic rhinosinusitis (CRS) with nasal polyposis (NP) can be associated with aspirin hypersensitivity, representing a syndrome of aspirin-exacerbated respiratory disease (AERD). While the pathophysiology of allergic respiratory diseases has been well studied, our understanding of nonallergic CRS and its impact on asthma is still a matter of debate. 1 There is a gap in clinical and pathophysiological knowledge on the effect of upper airway diseases, especially of CRS with NP, on asthma. Nasal endoscopy, computed tomography (CT) imaging, and clinical symptoms are all helpful in establishing the diagnosis, 2 but provide no information about the etiology and lower airway comorbidity of CRS with NP. The medical management of CRS is currently focused on the control of inflammation that aggravates nasal obstruction. Surgical interventions

Diagnostic Utility of Urinary LTE4 in Asthma, Allergic Rhinitis, Chronic Rhinosinusitis, Nasal Polyps, and Aspirin Sensitivity

“…Allergic rhinitis and CRSsNP were not associated with significant increases in urinary LTE4 excretion. Because aspirin sensitivity has been shown to be a determinant in driving urinary LTE4 excretion, 8,11,12,15 we performed additional analysis to adjust for the presence of history of aspirin sensitivity as a covariate. In this model, urinary LTE4 excretion was no longer significantly different between those who had asthma versus those who did not have the diagnosis of asthma ( P = .18) or those patients with any respiratory diagnosis versus those without ( P = .73).…”

“…8,16 In addition, the value of 951 pg/mg Cr was chosen because it was the closest value in our analysis to 859 pg/mg Cr, a suggested value with high specificity. 11 The specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for these values for presence of history of aspirin sensitivity and for challenge-confirmed aspirin sensitivity are presented in Tables IV and V, respectively. The concentration at which 24-hour urinary LTE4 used as a test could discriminate history of aspirin sensitivity alone before a challenge with best balance of test parameters was 166 pg/mg Cr (sensitivity of 76.4% and specificity of 89.2%).…”

“…Increased LTE4 excretion has been demonstrated in allergen-induced asthma, asthma exacerbations, aspirin challenge, and increased basal excretion in AERD. 11–13,17–19 In this study, we wished to determine the diagnostic utility of 24-hour urinary LTE4 based on established and derived values. Because aspirin sensitivity strongly influences LTE4 excretion, 12,16 we adjusted for this status to account for the possible effect on analysis of CRSwNP and asthma states.…”

“…For this condition, a value of 393 pg/mg Cr had the highest DOR of 61.7, with increased PPV (71.4%) but with reduced sensitivity (58.8%). Celejewska-Wojcik et al 11 have reported that for spot urinary LTE4 values ranging from 184 to 859 pg/mg Cr, specificity of discrimination increases from 37.5% to 93.7% between aspirin-tolerant patients with CRS and patients with AERD and have suggested a value of 859 pg/mg Cr as the best diagnostic value prechallenge. There may be a few reasons for this difference in observation.…”

“…9,10 In addition, most studies to date documenting an increase in urinary LTE4 in aspirin sensitivity have used an immunoassay. In addition, studies have used urine spot specimen 11–13 rather than 24-hour collection and the reported variability in urinary LTE4 production may influence these findings. 14 In the present study, we performed a “real-world” retrospective analysis of the utility of 24-hour urinary LTE4 as measured by clinically validated liquid chromatography/mass spectrometry (LC-MS) in subjects with clinical diagnoses of allergic rhinitis, asthma, CRS with or without NP, and aspirin sensitivity.…”