Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Dec;9(12):1401-1408.
doi: 10.1002/alr.22418. Epub 2019 Sep 30.

Endoscopic sinus surgery improves aspirin treatment response in aspirin-exacerbated respiratory disease patients

Sharan J Shah  1 , Waleed M Abuzeid  1 , Anusha Ponduri  1 , Teresa Pelletier  2 , Zhen Ren  3 , Taha Keskin  2 , Gigia Roizen  2 , David Rosenstreich  2 , Denisa Ferastraoaru  2 , Elina Jerschow  2
Affiliations
Free PMC article
Observational Study

Endoscopic sinus surgery improves aspirin treatment response in aspirin-exacerbated respiratory disease patients

Sharan J Shah et al. Int Forum Allergy Rhinol. 2019 Dec.
Free PMC article

Abstract

Background: Aspirin desensitization and treatment benefits most patients with aspirin-exacerbated respiratory disease (AERD), although some patients fail therapy. Our objective was to assess whether recent endoscopic sinus surgery (ESS) improved aspirin treatment outcomes in AERD patients who initially failed aspirin therapy.

Methods: Outcomes of aspirin desensitization and treatment in AERD patients prospectively enrolled were assessed preoperatively and at 4, 12, and 24 weeks after ESS by determining changes in Asthma Control Test (ACT) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores and respiratory function. Biomarkers, including fractional excretion of nitric oxide (FeNO), spirometry, nasal inspiratory peak flow (NPF), immunoglobulin E (IgE), and eosinophil count, were measured.

Results: Nineteen patients who benefited (responders) and 21 patients who failed (nonresponders) preoperative aspirin treatment with a distant history of ESS (mean, 48 months) were identified. Nonresponders were more likely to be African American (71%, p < 0.01) and have higher baseline IgE levels (252 kU/L vs 87 kU/L in responders, p < 0.01). 24 of the 40 patients (nine responders and 15 non-responders) required subsequent ESS and underwent another aspirin desensitization 3-4 weeks after ESS. All 24 patients tolerated a second round of aspirin desensitization and treatment. The primary aspirin therapy was associated with a significant increase in IgE in nonresponders, but there was no significant increase in IgE after the second aspirin desensitization and treatment.

Conclusion: Antecedent ESS enhances aspirin treatment responses in AERD patients and may convert patients who failed aspirin treatment before surgery to a more responsive phenotype after ESS. Patients with higher baseline serum IgE levels may benefit from ESS performed shortly before aspirin desensitization and therapy.

Keywords: AERD; aspirin-induced asthma; asthma; nasal polyps; paranasal sinus diseases; sinusitis; treatment outcome.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: Waleed M. Abuzeid is a consultant for Medtronic, Inc and Intersect ENT. Elina Jerschow has research support from Cumberland Pharmaceuticals, Inc and serves on the Advisory Board for Sanofi/Regeneron and Genentech. None of these interests are relevant to the present work. Other authors have no conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
ACT (A) and RQLQ (B) outcomes in responders and non-responders on primary aspirin desensitization and therapy before ESS; vertical bars represent Interquartile Ranges
Figure 2:
Figure 2:
ACT and RQLQ changes in patients after ESS; vertical bars represent Interquartile Ranges
Figure 3:
Figure 3:
FEV1 % and NPF changes in patients after ESS; vertical bars represent Interquartile Ranges
Figure 4:
Figure 4:
Post-ESS Response of Aspirin Therapy as measured by ACT score (A), RQLQ score (B), NPF (C), and FEV1% (D); vertical bars represent Interquartile Ranges
Figure 5:
Figure 5:
Serum Eosinophil Count (A), IgE levels (B) and FeNO levels (C) changes in responders and non-responders to aspirin desensitization and therapy before ESS; vertical bars represent Interquartile Ranges
Figure 6:
Figure 6:
Post-ESS Changes to Aspirin Therapy as measured by Serum Eosinophil Count (A), IgE levels (B) and FeNO levels (C); vertical bars represent Interquartile Ranges
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Berges-Gimeno MP, Simon RA, Stevenson DD. Long-term treatment with aspirin desensitization in asthmatic patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2003;111(1):180–186. - PubMed
    1. Laidlaw TM, Boyce JA. Aspirin-Exacerbated Respiratory Disease--New Prime Suspects. N Engl J Med. 2016;374(5):484–488. - PubMed
    1. White AA, Stevenson DD. Aspirin-Exacerbated Respiratory Disease. N Engl J Med. 2018;379(11):1060–1070. - PubMed
    1. Woessner KM, White AA. Evidence-based approach to aspirin desensitization in aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2014;133(1):286–287 e281–289. - PubMed
    1. Stevenson DD, Szczeklik A. Clinical and pathologic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol. 2006;118(4):773–786; quiz 787–778. - PubMed

Publication types