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Observational Study
. 2019 May-Jun;7(5):1580-1588.
doi: 10.1016/j.jaip.2018.12.014. Epub 2018 Dec 21.

Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease

Elina Jerschow  1 , Matthew L Edin  2 , Yuling Chi  3 , Beth Hurst  4 , Waleed M Abuzeid  5 , Nadeem A Akbar  5 , Marc Gibber  5 , Marvin P Fried  5 , Weiguo Han  3 , Teresa Pelletier  3 , Zhen Ren  6 , Taha Keskin  5 , Gigia Roizen  5 , Fred B Lih  2 , Artiom Gruzdev  2 , J Alyce Bradbury  2 , Victor Schuster  5 , Simon Spivack  5 , David Rosenstreich  5 , Darryl C Zeldin  2
Affiliations
Free PMC article
Observational Study

Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease

Elina Jerschow et al. J Allergy Clin Immunol Pract. 2019 May-Jun.
Free PMC article

Abstract

Background: Nasal polyps influence the burden of aspirin-exacerbated respiratory disease (AERD) by contributing to eicosanoid production. AERD is diagnosed through graded aspirin challenges. It is not known how sinus surgery affects aspirin challenge outcomes.

Objective: To investigate the effects of endoscopic sinus surgery (ESS) on aspirin-induced reaction severity and on the levels of eicosanoids associated with these reactions.

Methods: Twenty-eight patients with AERD were challenged with aspirin before and 3 to 4 weeks after ESS. Respiratory parameters and plasma and urine levels of eicosanoids were compared before and after challenges.

Results: Before ESS, AERD diagnosis was confirmed in all study patients by aspirin challenges that resulted in hypersensitivity reactions. After ESS, reactions to aspirin were less severe in all patients and 12 of 28 patients (43%, P < .001) had no detectable reaction. A lack of clinical reaction to aspirin was associated with lower peripheral blood eosinophilia (0.1 K/μL [interquartile range (IQR) 0.1-0.3] vs 0.4 K/μL [IQR 0.2-0.8]; P = .006), lower urinary leukotriene E4 levels after aspirin challenge (98 pg/mg creatinine [IQR 61-239] vs 459 pg/mg creatinine [IQR 141-1344]; P = .02), and lower plasma prostaglandin D2 to prostaglandin E2 ratio (0 [±0] vs 0.43 [±0.2]; P = .03), compared with those who reacted.

Conclusions: Sinus surgery results in decreased aspirin sensitivity and a decrease in several plasma and urine eicosanoid levels in patients with AERD. Diagnostic aspirin challenges should be offered to patients with suspected AERD before ESS to increase diagnostic accuracy. Patients with established AERD could undergo aspirin desensitizations after ESS as the severity of their aspirin-induced hypersensitivity reactions lessens.

Keywords: Aspirin challenges; Aspirin-exacerbated respiratory disease; Eicosanoids; Endoscopic sinus surgery; Eosinophils; Nasal polyps.

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Conflict of interest statement

Conflicts of interest: Elina Jerschow has research support from Stony-Wold Herbert Fund and Cumberland Pharmaceuticals, Inc. (not relevant to the present study). Waleed M. Abuzeid is a consultant for Medtronic, Inc. Other authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Baseline urinary LTE4 levels before and after ESS (1A) and after aspirin challenges (1B). Baseline urinary PGDM levels before and after ESS (1C) and after aspirin challenges (1D).
Figure 1.
Figure 1.
Baseline urinary LTE4 levels before and after ESS (1A) and after aspirin challenges (1B). Baseline urinary PGDM levels before and after ESS (1C) and after aspirin challenges (1D).
Figure 1.
Figure 1.
Baseline urinary LTE4 levels before and after ESS (1A) and after aspirin challenges (1B). Baseline urinary PGDM levels before and after ESS (1C) and after aspirin challenges (1D).
Figure 1.
Figure 1.
Baseline urinary LTE4 levels before and after ESS (1A) and after aspirin challenges (1B). Baseline urinary PGDM levels before and after ESS (1C) and after aspirin challenges (1D).
Figure 2.
Figure 2.
Baseline plasma lipoxin A4 levels before and after ESS.
Figure 3.
Figure 3.
Changes in urinary LTE4 (3A) and PGDM (3B) in urine during aspirin challenges after ESS in patients with and without clinical reactions to aspirin challenges.
Figure 3.
Figure 3.
Changes in urinary LTE4 (3A) and PGDM (3B) in urine during aspirin challenges after ESS in patients with and without clinical reactions to aspirin challenges.
Figure 4.
Figure 4.
Plasma PGD2/PGE2 ratio (4A), and plasma levels of PGD2 (4B), PGE2 (4C), and lipoxin A4 (4D) in patients with and without clinical reactions to aspirin challenges.
Figure 4.
Figure 4.
Plasma PGD2/PGE2 ratio (4A), and plasma levels of PGD2 (4B), PGE2 (4C), and lipoxin A4 (4D) in patients with and without clinical reactions to aspirin challenges.
Figure 4.
Figure 4.
Plasma PGD2/PGE2 ratio (4A), and plasma levels of PGD2 (4B), PGE2 (4C), and lipoxin A4 (4D) in patients with and without clinical reactions to aspirin challenges.
Figure 4.
Figure 4.
Plasma PGD2/PGE2 ratio (4A), and plasma levels of PGD2 (4B), PGE2 (4C), and lipoxin A4 (4D) in patients with and without clinical reactions to aspirin challenges.
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