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

Sharan J. Shah, Waleed M. Abuzeid, Anusha Ponduri, Teresa Pelletier, Zhen Ren, Taha Keskin, Gigia Roizen, David Rosenstreich, Denisa Ferastraoaru, Elina Jerschow

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalInternational Forum of Allergy and Rhinology
DOIs
StateAccepted/In press - Jan 1 2019

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Aspirin
Immunoglobulin E
Therapeutics
Spirometry
Nose
Eosinophils
African Americans
Nitric Oxide
Asthma
Biomarkers
Quality of Life

Keywords

  • AERD
  • aspirin-induced asthma
  • asthma
  • nasal polyps
  • paranasal sinus diseases
  • sinusitis
  • treatment outcome

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Endoscopic sinus surgery improves aspirin treatment response in aspirin-exacerbated respiratory disease patients. / Shah, Sharan J.; Abuzeid, Waleed M.; Ponduri, Anusha; Pelletier, Teresa; Ren, Zhen; Keskin, Taha; Roizen, Gigia; Rosenstreich, David; Ferastraoaru, Denisa; Jerschow, Elina.

In: International Forum of Allergy and Rhinology, 01.01.2019.

Research output: Contribution to journalArticle

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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.",
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author = "Shah, {Sharan J.} and Abuzeid, {Waleed M.} and Anusha Ponduri and Teresa Pelletier and Zhen Ren and Taha Keskin and Gigia Roizen and David Rosenstreich and Denisa Ferastraoaru and Elina Jerschow",
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AU - Shah, Sharan J.

AU - Abuzeid, Waleed M.

AU - Ponduri, Anusha

AU - Pelletier, Teresa

AU - Ren, Zhen

AU - Keskin, Taha

AU - Roizen, Gigia

AU - Rosenstreich, David

AU - Ferastraoaru, Denisa

AU - Jerschow, Elina

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KW - nasal polyps

KW - paranasal sinus diseases

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KW - treatment outcome

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