The role of aspirin desensitization in patients with aspirin-exacerbated respiratory disease (AERD)

Spies, Jonas Willian; Valera, Fabiana Cardoso Pereira; Cordeiro, Daniel; Mendonça, Taís Nociti de; Leite, Marcelo Gonçalves Junqueira; Tamashiro, Edwin; Arruda, L. Karla; Anselmo‐Lima, Wilma Terezinha

doi:10.1016/j.bjorl.2015.04.010

Cited by 15 publications

(23 citation statements)

References 25 publications

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“…A similar review of literature data made by Adelman et al [24] highlights the clear improvement in sinonasal symptom severity and frequency, endoscopy score, quality of life, and asthma severity. In postoperative treatment, aspirin desensitization or inclusion of LTRAs are suggested [25, 26]. In the literature cited, in contrast to our observations, an improvement in the sense of smell was found more often together with improved SNOT-22 values.…”

Section: Discussioncontrasting

confidence: 55%

The Effect of Antileukotrienes on the Results of Postoperative Treatment of Paranasal Sinuses in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease

Stryjewska-Makuch¹,

Humeniuk-Arasiewicz²,

Jura-Szołtys³

et al. 2019

Int Arch Allergy Immunol

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Background: Based on endoscopic examination, chronic rhinosinusitis (CRS) is divided into chronic inflammation with (CRSwNP) or without nasal polyps (CRSsNP). On the basis of the pathomechanism of inflammation, CRS is divided into endotypes. Eosinophilic CRSwNP with coexisting bronchial asthma and hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is a real therapeutic challenge. Aim: Comparative analysis of the results of treatment of patients with CRSwNP, bronchial asthma, or hypersensitivity to NSAIDs (NSAID-exacerbated respiratory disease, NERD), using antileukotrienes (leukotriene receptor antagonists, LTRAs) or intranasal glucocorticoids or both drugs together after endoscopic sinus surgery (ESS). Material and Methods: 33 patients (11 male, 33%) with NERD divided into three groups treated with LTRAs or intranasal glucocorticoids or both drugs together were assessed in terms of general well-being, state of pathological changes, and olfactory disorders using the following tools: Sino-Nasal Outcome Test, Visual Analogue Scale, Brief Identification Smell Test, and Lund-Kennedy score before and at 12 months after surgery. CT assessments were made prior to surgery using the Lund-MacKay scale. Results: Comparable efficacy of treatment with nasal steroids and antileukotrienes was found after 12 months of observation of patients. Conclusions: The results suggest comparable efficacy of treatment with nasal steroids and antileukotrienes in patients with NERD after ESS. Treatment with montelukast and mometasone has not been shown to be superior to both drugs administered separately.

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Section: Discussioncontrasting

confidence: 55%

The Effect of Antileukotrienes on the Results of Postoperative Treatment of Paranasal Sinuses in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease

Stryjewska-Makuch¹,

Humeniuk-Arasiewicz²,

Jura-Szołtys³

et al. 2019

Int Arch Allergy Immunol

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“…In total, 3330 references were imported for screening, and 24 studies were included for extraction (Fig. and Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Unfortunately, not all studies reported in depth the details of their NSSs. In total, NSSs were reported in 14 studies and 13 studies (92.9%) showed improvement with desensitization.…”

Section: Resultsmentioning

confidence: 99%

Aspirin desensitization therapy in aspirin‐exacerbated respiratory disease: a systematic review

Larivée

Chin

2020

Int Forum Allergy Rhinol

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Background: Aspirin-exacerbated respiratory disease (AERD) represents an aggressive form of chronic rhinosinusitis with nasal polyposis that is notoriously challenging to treat. There is evidence to suggest desensitization to aspirin may improve symptomatology and disease control in these patients. The goal of our study was to critically appraise the literature on this topic and assess the effect of desensitization on sinonasal symptomatology. Methods:We searched EMBASE, CINAHL, MEDLINE, and the Cochrane Library for relevant literature. Studies were included if they were observational studies or randomized, controlled trials, had n > 1, and were published in English or French. Studies were excluded if they were systematic reviews. We assessed study for quality and presence of common sources of bias. Results:Twenty-four studies met the inclusion criteria. In general, polyp size, polyp recurrence, nasal symptom scores, sense of smell, number of acute rhinosinusitis episodes, and systemic steroid use improved when patients were desensitized. The vast majority of studies recommend desensitization. Conclusion:There is mounting evidence that aspirin desensitization is a valuable adjunct to treat sinonasal symptoms in the treatment of patients who have AERD. C 2020 ARS-AAOA, LLC.

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“…This review identified 1 systematic review and 7 RCTs evaluating the impact of aspirin desensitization on symptoms of CRSwNP in AERD (Table ). Three cohort studies and 12 case series were excluded from analysis due to a low level of evidence. The highest‐quality study by Xu et al .…”

Section: Results: Contemporary Management Of Crs In Aerdmentioning

confidence: 99%

Contemporary management of chronic rhinosinusitis with nasal polyposis in aspirin‐exacerbated respiratory disease: an evidence‐based review with recommendations

Levy

Rudmik

Peters

et al. 2016

Int Forum Allergy Rhinol

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Background Chronic rhinosinusitis (CRS) in aspirin exacerbated respiratory disease (AERD) represents a recalcitrant form of sinonasal inflammation for which a multidisciplinary consensus on patient management has not been reached. Several medical interventions have been investigated, but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach for the multidisciplinary management of CRS in AERD. Methods A systematic review of the literature was performed and the guidelines for development of an evidence-based review with recommendations were followed. Study inclusion criteria included: adult population>18 years old; CRS based on published diagnostic criteria and a presumptive diagnosis of AERD. We focused on reporting higher-quality studies (level 2 or higher) when available, but reported lower-quality studies if the topic contained insufficient evidence. Treatment recommendations were based on American Academy of Otolaryngology guidelines, with defined grades of evidence and evaluation of research quality and risk/benefits associated with each treatment. Results This review identified and evaluated the literature on 3 treatment strategies for CRS in AERD: dietary salicylate avoidance, leukotriene modification and desensitization with daily aspirin therapy. Conclusion Based on the available evidence, dietary salicylate avoidance and leukotriene modifying drugs are options following appropriate treatment with nasal corticosteroids and saline irrigation. Desensitization with daily aspirin therapy is recommended following revision ESS.

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The role of aspirin desensitization in patients with aspirin-exacerbated respiratory disease (AERD)

Abstract: Aspirin desensitization, when tolerated, was effective in patients with AERD and with poor clinical/surgical response.

Cited by 15 publications

References 25 publications

The Effect of Antileukotrienes on the Results of Postoperative Treatment of Paranasal Sinuses in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease

The Effect of Antileukotrienes on the Results of Postoperative Treatment of Paranasal Sinuses in Patients with Non-Steroidal Anti-Inflammatory Drug-Exacerbated Respiratory Disease

Aspirin desensitization therapy in aspirin‐exacerbated respiratory disease: a systematic review

Contemporary management of chronic rhinosinusitis with nasal polyposis in aspirin‐exacerbated respiratory disease: an evidence‐based review with recommendations

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