Clinical pictures of phenotypes of intolerance to aspirin and other nonsteroidal anti-inflammatory drugs. Part I

Department of Pneumonology and Allergology, First Faculty of Internal Medicine, Medical University of Łódź, Łódź, Poland. Head of the Department: Professor Paweł Górski, MD, PhD
Correspondence: Professor Iwona Grzelewska-Rzymowska, MD, PhD, Department of Pneumonology and Allergology, First Faculty of Internal Medicine, First Faculty of Internal Medicine, Medical University of Łódź, Kopcińskiego 22, 90-153 Łódź, Poland, tel.: +48 42 678 75 05, e-mail: rzym@binar.pl

Pediatr Med rodz Vol 10 Numer 4, p. 346–359
DOI: 10.15557/PiMR.2014.0036
ABSTRACT

Clinically, three phenotypes of intolerance to aspirin and other nonsteroidal anti-inflammatory drugs are distinguished: bronchospastic phenotype, urticaria/oedema and chronic hyperplastic eosinophilic sinusitis. Recently, the term aspirinexacerbated respiratory disease has been proposed for an aspirin-intolerant respiratory disease. The bronchospastic phenotype of aspirin sensitivity, called aspirin-intolerant asthma, occurs only in patients with asthma. In these individuals, the symptoms of aspirin sensitivity include dyspnoea and extrabronchial symptoms, such as: watery rhinorrhoea, conjunctivitis and lacrimation, flushing of the face and neck, oedema of the larynx, fall in blood pressure and even death. Aspirin-intolerant urticaria/angioedema occurs mainly in patients with chronic or recurrent urticaria and angioedema. The typical features of aspirin-intolerant asthma are nasal and paranasal polyps. They occur almost in 80% of patients with aspirin-intolerant asthma, and in only 3% of those with aspirin-intolerant urticaria. Bronchial and nasal mucosae are inflamed mainly with eosinophils. Aspirin-intolerant asthma and urticaria/angioedema can occur at any age, but they especially affect women between 30 and 50 years of age. In about 50% of aspirin-intolerant asthmatics, atopic features were found. The clinical course of aspirin-intolerant asthma is usually severe, but total or partial control can be achieved with the use of inhaled corticosteroids and long-acting β2-agonists. The authors assume that anamnesis plays the major role in the detection of intolerance to aspirin. Oral challenge tests should be applied only with the use of acetylsalicylic acid, administered at low, increasing doses at intervals not shorter than 24 hours. The majority of nonsteroidal anti-inflammatory drugs elicit dyspnoea in patients with aspirin-intolerant asthma and skin eruptions in those with aspirin-intolerant urticaria. Sometimes nasal and inhalation tests with lysine aspirin are performed. These tests are safer, but less sensitive and for that reason, oral challenge with acetylsalicylic acid is treated as “the gold standard.” In patients with aspirin-intolerant asthma and aspirin-intolerant urticaria, tolerance to acetylsalicylic acid is achieved by using increasing doses of aspirin.

Keywords: sensitivity to aspirin, aspirin-intolerant asthma, aspirin-intolerant urticaria, aspirin-intolerant angioedema, nonsteroidal anti-inflammatory drugs, tolerance to aspirin