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Diagnosis of Aspirin Sensitivity in Aspirin Exacerbated Respiratory Disease

  • Marek L. Kowalski
Part of the Allergy Frontiers book series (ALLERGY, volume 4)

Ingestion of aspirin or other non-steroidal anti-inflammatory drug (NSAID) may induce a severe asthmatic attack in a subpopulation of asthmatic patients. The reaction is not immunological but is related to inhibition by aspirin of cyclooxygenase-1, which triggers a mechanism leading to asthmatic attack.

And although in majority of ASA-sensitive patients history of drug- induced adverse reaction is quite convincing it is not always reliable and in several instances confirmation by in vitro tests and/or controlled aspirin challenge is necessary. Oral challenge is the gold standard for the diagnosis but nasal or bronchial provocation with lysine-ASA may be a valuable alternative to confirm drug hypersensitivity in asthmatic patients

In vitro tests to distinguish aspirin sensitive from insensitive individuals have not been standardized, but maybe helpful if experienced hands. Assessment of increased expression of CD63 on peripheral blood leukocyte following in vitro stimulation with aspirin or measurement of aspirin-triggered 15-HETE release from PBL (ASPITest) may be valuable tools to confirm aspirin sensitivity.

Diagnosis of ASA-hypersensitivity should be followed by patient's education and careful avoidance of ASA and NSAIDs. Selective cyclooxygenase-2 inhibitors (e.g. celecoxib) may be safe and effective alternative for treatment in ASA-sensitive patients if analgesic and anti-inflammatory treatment is indicated

Keywords

Allergy Clin Immunol Nasal Polyp Nasal Polyposis Aspirin Sensitivity Aspirin Intolerance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer 2009

Authors and Affiliations

  • Marek L. Kowalski
    • 1
  1. 1.Department of Immunology, Rheumatology and Allergy, Chair of Immunology, Faculty of MedicineMedical University of ŁódzŁódzPoland

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