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

Elina Jerschow, Matthew L. Edin, Yuling Chi, Beth Hurst, Waleed M. Abuzeid, Nadeem A. Akbar, Marc J. Gibber, Marvin P. Fried, Weiguo Han, Teresa Pelletier, Zhen Ren, Taha Keskin, Gigia Roizen Gottlieb, Fred B. Lih, Artiom Gruzdev, J. Alyce Bradbury, Victor L. Schuster, Simon D. Spivack, David L. Rosenstreich, Darryl C. Zeldin

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology: In Practice
DOIs
StateAccepted/In press - Jan 1 2019

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Aspirin
Eicosanoids
Creatinine
Hypersensitivity
Urine
Leukotriene E4
Nasal Polyps
Prostaglandin D2
Eosinophilia
Dinoprostone

Keywords

  • Aspirin challenges
  • Aspirin-exacerbated respiratory disease
  • Eicosanoids
  • Endoscopic sinus surgery
  • Eosinophils
  • Nasal polyps

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease. / Jerschow, Elina; Edin, Matthew L.; Chi, Yuling; Hurst, Beth; Abuzeid, Waleed M.; Akbar, Nadeem A.; Gibber, Marc J.; Fried, Marvin P.; Han, Weiguo; Pelletier, Teresa; Ren, Zhen; Keskin, Taha; Gottlieb, Gigia Roizen; Lih, Fred B.; Gruzdev, Artiom; Bradbury, J. Alyce; Schuster, Victor L.; Spivack, Simon D.; Rosenstreich, David L.; Zeldin, Darryl C.

In: Journal of Allergy and Clinical Immunology: In Practice, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease",
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",
author = "Elina Jerschow and Edin, {Matthew L.} and Yuling Chi and Beth Hurst and Abuzeid, {Waleed M.} and Akbar, {Nadeem A.} and Gibber, {Marc J.} and Fried, {Marvin P.} and Weiguo Han and Teresa Pelletier and Zhen Ren and Taha Keskin and Gottlieb, {Gigia Roizen} and Lih, {Fred B.} and Artiom Gruzdev and Bradbury, {J. Alyce} and Schuster, {Victor L.} and Spivack, {Simon D.} and Rosenstreich, {David L.} and Zeldin, {Darryl C.}",
year = "2019",
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journal = "Journal of Allergy and Clinical Immunology: In Practice",
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T1 - Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease

AU - Jerschow, Elina

AU - Edin, Matthew L.

AU - Chi, Yuling

AU - Hurst, Beth

AU - Abuzeid, Waleed M.

AU - Akbar, Nadeem A.

AU - Gibber, Marc J.

AU - Fried, Marvin P.

AU - Han, Weiguo

AU - Pelletier, Teresa

AU - Ren, Zhen

AU - Keskin, Taha

AU - Gottlieb, Gigia Roizen

AU - Lih, Fred B.

AU - Gruzdev, Artiom

AU - Bradbury, J. Alyce

AU - Schuster, Victor L.

AU - Spivack, Simon D.

AU - Rosenstreich, David L.

AU - Zeldin, Darryl C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Aspirin challenges

KW - Aspirin-exacerbated respiratory disease

KW - Eicosanoids

KW - Endoscopic sinus surgery

KW - Eosinophils

KW - Nasal polyps

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