Aspirin intolerance and the cyclooxygenase-leukotriene pathways

Curr Opin Pulm Med. 2004 Jan;10(1):51-6. doi: 10.1097/00063198-200401000-00009.


Purpose of review: In up to 10% of patients with bronchial asthma, aspirin and other nonsteroidal antiinflammatory drugs precipitate asthmatic attacks. This is a hallmark of a distinct clinical syndrome that develops according to a characteristic sequence of symptoms. Here we discuss its clinical picture and management as related to the abnormalities in arachidonic acid transformations.

Recent findings: At the biochemical level, the characteristic feature is profound alteration in eicosanoid biosynthesis and metabolism. Major advances in the molecular biology of eicosanoids, exemplified by the cloning of cysteinyl-leukotriene receptors and discovery of a whole family of cyclooxygenase enzymes, offer new insights into mechanisms operating in aspirin-induced asthma. Clinical interest has been enhanced by the introduction into therapy of highly specific cyclooxygenase-2 inhibitors and antileukotriene drugs.

Summary: Recent studies have improved our understanding of mechanisms operating in asthma and unvieled the role of eicosanoid mediators in pulmonary disease.

Publication types

  • Review

MeSH terms

  • Aspirin / adverse effects*
  • Asthma / chemically induced*
  • Asthma / diagnosis
  • Asthma / drug therapy
  • Asthma / epidemiology
  • Asthma / physiopathology*
  • Cyclooxygenase 2
  • Cyclooxygenase 2 Inhibitors
  • Cyclooxygenase Inhibitors / adverse effects*
  • Desensitization, Immunologic
  • Humans
  • Isoenzymes / antagonists & inhibitors
  • Leukotrienes / metabolism
  • Lipoxins / physiology
  • Mast Cells / physiology
  • Membrane Proteins
  • Prostaglandin-Endoperoxide Synthases
  • Rhinitis / epidemiology
  • Sinusitis / epidemiology


  • Cyclooxygenase 2 Inhibitors
  • Cyclooxygenase Inhibitors
  • Isoenzymes
  • Leukotrienes
  • Lipoxins
  • Membrane Proteins
  • Cyclooxygenase 2
  • PTGS2 protein, human
  • Prostaglandin-Endoperoxide Synthases
  • Aspirin