Sinus surgery is associated with a decrease in aspirin-induced reaction severity in AERD patients

Publication date: Available online 21 December 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

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

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 AERD patients were challenged with aspirin before and 3-4 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 twelve out of twenty-eight patients (43%, p<0.001) had no detectable reaction. A lack of clinical reaction to aspirin was associated with lower peripheral blood eosinophilia [0.1 K/μL (IQR 0.1-0.3) vs. 0.4 K/μL (IQR 0.2-0.8), p=0.006], lower urinary leukotriene E₄ (LTE₄) levels after aspirin challenge [98 pg/mg creatinine (IQR 61-239) vs. 459 pg/mg creatinine (IQR 141-1344) , p=0.02], and lower plasma prostaglandin D₂ to prostaglandin E₂ (PGD₂/PGE₂) ratio [0 (±0) vs. 0.43 (±0.2), p=0.03], compared to those who reacted..

Conclusions

Sinus surgery results in decreased aspirin sensitivity and a decrease in several plasma and urine eicosanoid levels in AERD patients. Diagnostic aspirin challenges should be offered to patients with suspected AERD prior to 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.

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