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Hypersensitivity to Aspirin and other NSAIDs: Diagnostic Approach in Patients with Chronic Rhinosinusitis.

Makowska J, Lewandowska-Polak A, Kowalski ML - Curr Allergy Asthma Rep (2015)

Bottom Line: Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) associated with chronic rhinosinusitis (CRS) and/or asthma comprises a distinct clinical syndrome referred to as NSAIDs exacerbated respiratory disease (NERD).Patients with NERD tend to have more severe course of both upper (CRS and nasal polyps) and lower airway (asthma) diseases and are usually recalcitrant to conventional treatment modalities.Diagnosing and phenotyping of patients with NERD are critical for prevention of drug-induced adverse reactions and open novel options for management of underlying chronic airway inflammatory diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Center, Medical University of Łódź, 251 Pomorska Str., 92-213, Łódź, Poland.

ABSTRACT
Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) associated with chronic rhinosinusitis (CRS) and/or asthma comprises a distinct clinical syndrome referred to as NSAIDs exacerbated respiratory disease (NERD). Patients with NERD tend to have more severe course of both upper (CRS and nasal polyps) and lower airway (asthma) diseases and are usually recalcitrant to conventional treatment modalities. Diagnosing and phenotyping of patients with NERD are critical for prevention of drug-induced adverse reactions and open novel options for management of underlying chronic airway inflammatory diseases. Diagnosis of NERD is based on detailed clinical history confirmed by challenge with aspirin, but new diagnostic approaches are currently being developed. This review article focuses on the diagnostic approach to a patient with CRS and hypersensitivity to NSAIDs, emphasizing the importance of diagnosis for proper patient's management.

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Clinical characteristics of NSAID exacerbated respiratory disease (modified from M.L .Kowalski, S. Bavbek, Aspirin Exacerbated Respiratory Disease, in Global Atlas of Asthma, Eds. C.A. Akdis, I. Agache, pp 92-94, EAACI 2013)
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Fig1: Clinical characteristics of NSAID exacerbated respiratory disease (modified from M.L .Kowalski, S. Bavbek, Aspirin Exacerbated Respiratory Disease, in Global Atlas of Asthma, Eds. C.A. Akdis, I. Agache, pp 92-94, EAACI 2013)

Mentions: History of hypersensitivity to aspirin and other NSAIDs is a hallmark of particularly persistent and resistant to treatment form of rhinosinusitis, associated with recurrent nasal polyposis [5–8] (Fig. 1). Although NSAIDs can evoke hypersensitivity reactions in patients with CRS, but without lower airway involvement, the majority of patients would suffer from chronic bronchial asthma. The higher than usual severity of the upper airway disease in NERD patients is reflected by recurrence of nasal polyps and frequent need for sinus surgery [7, 9]. As it has been documented with computer tomography in these patients, mucosal hypertrophy usually involves all sinuses and nasal passages and has significantly higher extent and thickness compared to CRS in aspirin tolerant patients [10].Fig. 1


Hypersensitivity to Aspirin and other NSAIDs: Diagnostic Approach in Patients with Chronic Rhinosinusitis.

Makowska J, Lewandowska-Polak A, Kowalski ML - Curr Allergy Asthma Rep (2015)

Clinical characteristics of NSAID exacerbated respiratory disease (modified from M.L .Kowalski, S. Bavbek, Aspirin Exacerbated Respiratory Disease, in Global Atlas of Asthma, Eds. C.A. Akdis, I. Agache, pp 92-94, EAACI 2013)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4493793&req=5

Fig1: Clinical characteristics of NSAID exacerbated respiratory disease (modified from M.L .Kowalski, S. Bavbek, Aspirin Exacerbated Respiratory Disease, in Global Atlas of Asthma, Eds. C.A. Akdis, I. Agache, pp 92-94, EAACI 2013)
Mentions: History of hypersensitivity to aspirin and other NSAIDs is a hallmark of particularly persistent and resistant to treatment form of rhinosinusitis, associated with recurrent nasal polyposis [5–8] (Fig. 1). Although NSAIDs can evoke hypersensitivity reactions in patients with CRS, but without lower airway involvement, the majority of patients would suffer from chronic bronchial asthma. The higher than usual severity of the upper airway disease in NERD patients is reflected by recurrence of nasal polyps and frequent need for sinus surgery [7, 9]. As it has been documented with computer tomography in these patients, mucosal hypertrophy usually involves all sinuses and nasal passages and has significantly higher extent and thickness compared to CRS in aspirin tolerant patients [10].Fig. 1

Bottom Line: Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) associated with chronic rhinosinusitis (CRS) and/or asthma comprises a distinct clinical syndrome referred to as NSAIDs exacerbated respiratory disease (NERD).Patients with NERD tend to have more severe course of both upper (CRS and nasal polyps) and lower airway (asthma) diseases and are usually recalcitrant to conventional treatment modalities.Diagnosing and phenotyping of patients with NERD are critical for prevention of drug-induced adverse reactions and open novel options for management of underlying chronic airway inflammatory diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Center, Medical University of Łódź, 251 Pomorska Str., 92-213, Łódź, Poland.

ABSTRACT
Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) associated with chronic rhinosinusitis (CRS) and/or asthma comprises a distinct clinical syndrome referred to as NSAIDs exacerbated respiratory disease (NERD). Patients with NERD tend to have more severe course of both upper (CRS and nasal polyps) and lower airway (asthma) diseases and are usually recalcitrant to conventional treatment modalities. Diagnosing and phenotyping of patients with NERD are critical for prevention of drug-induced adverse reactions and open novel options for management of underlying chronic airway inflammatory diseases. Diagnosis of NERD is based on detailed clinical history confirmed by challenge with aspirin, but new diagnostic approaches are currently being developed. This review article focuses on the diagnostic approach to a patient with CRS and hypersensitivity to NSAIDs, emphasizing the importance of diagnosis for proper patient's management.

Show MeSH
Related in: MedlinePlus