Hypersensitivity to aspirin and nonsteroidal anti-inflammatory drugs

Abstract

In about 10% of adult asthmatic patients, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit arachidonic acid cyclooxygenase (COX-1 and COX-2) precipitate attacks of dyspnea and naso-ocular reactions. This distinct clinical syndome, called aspirin-induced asthma (AIA), is characterized by a typical sequence of symptoms, intense eosinophilic inflammation of nasal and bronchial mucous membranes combined with overproduction of cysteinyl-leukotrienes. Although the clinical history may raise suspicion of aspirin intolerance the diagnosis can be established with certainty only by aspirin challenge. Avoiding aspirin and NSAIDs does not prevent progression of the inflammatory disease. In most patients with AIA aspirin desensitization (daily ingestion of high doses of aspirin) reduces symptoms, particularly in the nasal passages.