Aspirinin artırdığı solunumsal hastalık (Aspirin duyarlı astım, Aspirin ile indüklenen astım, Samter triadı)

Öz

Aspirin-exacerbated respiratory disease (AERD) is an aggressive and progressive inflammatory airway disease characterised with attacks of asthma and rhinitis after ingestion of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin hypersensitivity is present in 13.6% of asthmatic patients in Turkey. AERD should be considered especially in cases with a history of dyspnea or asthma attack related to ingestion of aspirin or NSAIDs, chronic and intractable nasal congestion, rinorrhea together with abscence of atopy, nasal poliposis, pansinusitis and severe asthma attacks, without a specific triggering factor, which requires hospitalization in intensive care unit. Diagnosis of AERD is based on aspirin provocation test. Aspirin desensitization is suggested in AERD patients with intractable symptoms despite medical treatment, recurrent nasal polyps requiring multiple surgeries, nasal symptoms and/or asthma requiring frequent systemic corticosteroid use and in case of additional medical indication for aspirin. Aspirin desesnsitization is a clinically- and cost-effective treatment method.

Anahtar Kelimeler

• Aspirin
• asthma
• desensitization

ASPİRİNİN ARTIRDIĞI SOLUNUMSAL HASTALIK (ASPİRİN DUYARLI ASTIM, ASPİRİN İLE İNDÜKLENEN ASTIM, SAMTER TRİADI)

Öz

Aspirinin artırdığı solunumsal hastalık (AASH) aspirin veya çoğu nonsteroidal antiinflamatuvar ilaçların (NSAII) alımından sonra görülen astım alevlenmeleri ve rinit atakları ile karakterize agresif ve süreğen inflamatuvar hava yolu hastalığıdır. Türkiye’de astımlı hastaların %13.6’sında aspirin duyarlılığı mevcuttur. Aspirin veya diğer NSAII’lar ile ilişkili dispne veya astım atağı öyküsü, kronik ve inatçı nazal konjesyon veya özellikle allerji cilt testlerinin negatifliğinde rinore, nazal polipozis, pansinüzit ve belirgin bir sebep olmaksızın yoğun bakım takibi gerektiren ağır astım atakları ile başvuran olgularda tanıda şüphelenilmelidir. AASH tanısının kesinleştirilmesi aspirin provokasyon testi ile mümkündür. Medikal tedaviye rağmen inatçı semptomları olan, multipl cerrahi gerektiren tekrarlayan nazal poliplerin ya da astım ve /veya nazal semptomları kontrol etmek için sık sistemik kortikosteroid ihtiyacı olan veya aspirin endikasyonu olan ek medikal durum varlığında AASH’lı hastalarda aspirin desensitizasyonu yapılabilir. Aspirin desensitizasyon tedavisinin klinik ve maliyet olarak etkin bir tedavi yöntemi olduğu gösterilmiştir.

Anahtar Kelimeler

• Aspirin
• asthma
• desensitization

Kaynakça

1. Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis, diagnosis, and management. J Allergy Clin Immunol 2003;111(5):913-21.
2. Stevenson DD, Szczeklik A. Clinical and pathologic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol 2006;118(4):773-86.
3. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C, Ortega Martell JA, Platts-Mills TA, Ring J, Thien F, Van Cauwenberge P, Williams HC. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 2004;113(5):832-6.
4. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004;328(7437):434.
5. Hedman J, Kaprio J, Poussa T, Nieminen MM. Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol 1999;28(4):717-22.
6. Bavbek S, Yılmaz I, Celik G, Aydın O, Erkekol FO, Orman A, Kurt E, Ediger D, Dursun B, Abadoğlu O, Ozşeker F, Akkaya E, Karakış GP, Canbakan S, Yüksel S, Mısırlıgil Z. Prevalence of aspirin-exacerbated respiratory disease in patients with asthma in Turkey: A cross-sectional survey. Allergol Immunopathol (Madr). 2012;40(4):225-30.
7. Berges-Gimeno MP, Simon RA, Stevenson DD. The natural history and clinical characteristics of aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 2002;89(5):474- 8.
8. Szczeklik A, Nizankowska E, Duplaga M. Natural history of aspirin-induced asthma. AIANE Investigators. European Network on Aspirin-Induced Asthma. Eur Respir J 2000;16(3):432-6.

9. Szczeklik A. Aspirin-induced asthma as a viral disease. Clin Allergy 1988;18(1):15-20. 10. Szczeklik A,
10. Nizankowska-Mogilnicka
11. Hypersensitivity to aspirin and non-steroidal anti-inflammatory
12. drugs. In: Adkinson NF Jr, Bochner BS, Busse WW, Holgate ST,
13. Lemanske RF Jr, Simons FER (eds.) Middleton’s allergy:
14. principles and practice. 7. Baskı. New York: Mosby; 2009. 1227- 43. E, Sanak M.
15. Lee RU, Stevenson DD. Aspirin-exacerbated respiratory disease: evaluation and management. Allergy Asthma Immunol Res 2011;3(1):3-10.
16. Szczeklik A, Sanak M. The broken balance in aspirin hypersensitivity. Eur J Pharmacol 2006;533(1-3):145-55.
17. Nizankowska E, Bestyńska-Krypel A, Cmiel A, Szczeklik A. Oral and bronchial provocation tests with aspirin for diagnosis of aspirin-induced asthma. Eur Respir J 2000;15(5):863-9.
18. Dursun AB, Woessner KA, Simon RA, Karasoy D, Stevenson DD. Predicting outcomes of oral aspirin challenges in patients with asthma, nasal polyps, and chronic sinusitis. Ann Allergy Asthma Immunol 2008;100(5):420-5.
19. Berges-Gimeno MP, Simon RA, Stevenson DD. The effect of leukotriene-modifier drugs on aspirin-induced asthma and rhinitis reactions. Clin Exp Allergy 2002;32(10):1491-6.
20. White AA, Stevenson DD, Simon RA. The blocking effect of essential controller medications during aspirin challenges in patients with aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 2005;95(4):330-5.
21. Mastalerz L, Milewski M, Duplaga M, Nizankowska E, Szczeklik A. Intranasal fluticasone propionate for chronic eosinophilic rhinitis in patients with aspirin-induced asthma. Allergy 1997;52(9):895-900.
22. McFadden EA, Woodson BT, Fink JN, Toohill RJ. Surgical treatment of aspirin triad sinusitis. Am J Rhinol 1997;11(4):263-70.
23. Daffern P, Muilenburg D, Hugli TE, Stevenson DD. Association of urinary leukotriene E4 excretion during aspirin challenges with severity of respiratory responses. J Allergy Clin Immunol 1999;104:559-64.
24. Juergens UR, Christiansen SC, Stevenson DD, Zuraw BL. Inhibition of monocyte leukotriene B4 production following aspirin desensitization. J Allergy Clin Immunol 1995;96:148-56.
25. Ferreri NR, Howland WC, Stevenson DD, Spiegelberg HL. Release of leukotrienes, prostaglandins, and histamine into nasal secretions of aspirin-sensitive asthmatics during reaction to aspirin. Am Rev Respir Dis 1988;137:847-54.
26. Aksu K, Kurt E, Alatas Ö, Gülbas Z. Effect of aspirin desensitization on T-cell cytokines and plasma lipoxins in aspirin- exacerbated 2014;35(2):148-55. Allergy Asthma Proc
27. Pleskow WW, Stevenson DD, Mathison DA, Simon RA, Schatz M, Zeiger RS. Aspirin desensitization in aspirin-sensitive asthmatic patients: clinical manifestations and characterization of the refractory period. J Allergy Clin Immunol. 1982;69:11-9.
28. Berges-Gimeno MP, Simon RA, Stevenson DD. Long-term treatment with aspirin desensitization in asthmatic patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 2003;111:180-6.
29. Berges-Gimeno MP, Simon RA, Stevenson DD. Early effects of aspirin desensitization treatment in asthmatic patients with aspirin- exacerbated respiratory disease. Ann Allergy Asthma Immunol 2003;90(3):338-41.
30. Stevenson DD, Hankammer MA, Mathison DA, Christiansen SC,Simon RA. Aspirin desensitization treatment of aspirin- sensitive patients with rhinosinusitis-asthma: long-term outcomes. J Allergy Clin Immunol 1996;98:751-8.
31. Sweet JM, Stevenson DD, Simon RA, Mathison DA. Long-term effects of aspirin desensitization--treatment for aspirin-sensitive rhinosinusitis-asthma. J Allergy Clin Immunol 1990;85:59-65.
32. Stevenson DD. Aspirin desensitization in patients with AERD. Clin Rev Allergy Immunol 2003;24(2):159-68.
33. Hope AP, Woessner KA, Simon RA, Stevenson DD. Rational approach to aspirin dosing during oral challenges and desensitization of patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 2009;123(2):406-10.
34. Shaker M, Lobb A, Jenkins P, O’Rourke D, Takemoto SK, Sheth S, Burroughs T, Dykewicz MS. An economic analysis of aspirin desensitization in aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 2008;121:81-7. http://edergi.cbu.edu.tr/ojs/index.php/cbusbed isimli
35. SBED başlıklı eseri bu Creative Commons Alıntı-Gayri ticari 4.0
36. Uluslararası Lisansı ile lisanslanmıştır. yazarın CBU