Aspirin exacerbated respiratory disease: Current topics and trends.

José Carlos Rodríguez-Jiménez, Fernanda Judith Moreno-Paz, Luis Manuel Terán, Eduardo Guaní-Guerra

Journal: Respiratory medicine 2018;135():62-75

PMID: 29414455

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Abstract

Aspirin-exacerbated respiratory disease is a chronic and treatment-resistant disease, characterized by the presence of eosinophilic rhinosinusitis, nasal polyposis, bronchial asthma, and nonsteroidal anti-inflammatory drugs hypersensitivity. Alterations in arachidonic acid metabolism may induce an imbalance between pro-inflammatory and anti-inflammatory substances, expressed as an overproduction of cysteinyl leukotrienes and an underproduction of prostaglandin E2. Although eosinophils play a key role, recent studies have shown the importance of other cells and molecules in the development of the disease like mast cells, basophils, lymphocytes, platelets, neutrophils, macrophages, epithelial respiratory cells, IL-33 and thymic stromal lymphopoietin, making each of them promissory diagnostic and treatment targets. In this review, we summarize the most important clinical aspects of the disease, including the current topics about diagnosis and treatment, like provocation challenges and aspirin desensitization. We also discuss recent findings in the pathogenesis of the disease, as well as future trends in diagnosis and treatment, including monoclonal antibodies and a low salicylate diet as a treatment option.

Address: Department of Medicine, University of Guanajuato, León, Guanajuato, Mexico.; Department of Immunogenetics, National Institute of Respiratory Diseases (INER), Mexico City, Mexico.; Department of Medicine, University of Guanajuato, León, Guanajuato, Mexico; Department of Immunology, Hospital Regional de Alta Especialidad del Bajío, León, Guanajuato, Mexico. Electronic address: [email protected].

DOI: 10.1016/j.rmed.2018.01.002

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MeSH Terms: Adult, Anti-Inflammatory Agents, Non-Steroidal, Antibodies, Monoclonal, Arachidonic Acid, Aspirin, Asthma, Asthma, Aspirin-Induced, Cysteine, Cytokines, Desensitization, Immunologic, Dinoprostone, Disease Progression, Drug Hypersensitivity Syndrome, Eosinophils, Female, Humans, Leukotrienes, Male, Mast Cells, Nasal Polyps, Respiratory Tract Diseases, Rhinitis, Sinusitis, Thymic Stromal Lymphopoietin