Aspirin-induced asthma: Advances in pathogenesis and management☆,☆☆
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DEFINITION AND CLINICAL PRESENTATION
AIA, also called aspirin-sensitive or aspirin-intolerant asthma, is an aggressive mucosal inflammatory disease combined with precipitation of asthma and rhinitis attacks after ingestion of ASA and most nonsteroidal anti-inflammatory drugs (NSAIDs). 4, 5, 6, 7 AIA affects about 10% of adults with asthma, more often women than men. 8 Familial occurrence is quite rare, and the disease is infrequently found in asthmatic children. 8
In most patients symptoms of rhinitis first occur during the third
The futile search for an allergic mechanism
Clinical symptoms precipitated by ASA or NSAIDs in patients with AIA are reminiscent of immediate hypersensitivity reactions. Therefore an underlying antigen-antibody mechanism has been suggested and investigated. However, skin test responses with ASA-lysine have been negative, and numerous attempts to demonstrate specific antibodies against ASA or its derivatives were unsuccessful. 14 Neither differences in bioavailability of ASA nor the formation of salicylic acid seem to contribute to
PREVENTION AND TREATMENT
The general rules concerning treatment of AIA do not differ from the published guidelines on the management of asthma. Most patients with AIA have moderate or severe persistent asthma. However, patients with AIA whose sinusitis is in remission may have mild asthma. These observations were recently confirmed by a multicenter study performed by participants of the European Network on Aspirin-Induced Asthma. Among 365 patients with AIA in the European Network on Aspirin-Induced Asthma study, 65
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