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J Allergy Clin Immunol Pract. 2017 Jul - Aug;5(4):990-997.e1. doi: 10.1016/j.jaip.2016.11.004. Epub 2017 Feb 12.

Urinary Leukotriene E4 to Determine Aspirin Intolerance in Asthma: A Systematic Review and Meta-Analysis.

Author information

1
Division of Allergic Diseases, Mayo Clinic, Rochester, Minn. Electronic address: hagan.john@mayo.edu.
2
Department of Medicine, Harvard Medical School, Boston, Mass.
3
Division of Allergic Diseases, Mayo Clinic, Rochester, Minn.
4
Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, Minn.
5
Division of Allergic Diseases, Mayo Clinic, Rochester, Minn; Department of Immunology, Mayo Clinic, Rochester, Minn.
6
Department of Biology, Baylor University, Waco, Texas.
7
Otorhinolaryngology, Mayo Clinic, Scottsdale, Ariz.
8
Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz.
9
Mayo Medical Library, Mayo Clinic, Rochester, Minn.
10
Research Biostatistics, Mayo Clinic, Scottsdale, Ariz.

Abstract

BACKGROUND:

Urinary leukotriene E4 (ULTE4) may be a biomarker that distinguishes aspirin-intolerant asthma from other asthma subtypes.

OBJECTIVE:

To estimate the diagnostic testing accuracy of ULTE4 as a marker of aspirin intolerance in patients with asthma using previously published studies.

METHODS:

We identified relevant clinical studies from a systematic review of English and non-English articles using MEDLINE, EMBASE, and CENTRAL (inception to February 10, 2015). Articles were screened at the abstract and full-text level by 2 independent reviewers. We included previously published studies that analyzed ULTE4 in human subjects with asthma characterized as having or not having aspirin intolerance on the basis of a specified definition: convincing history of aspirin intolerance, positive aspirin challenge, or both as the criterion standard. Individual-level data points from all included studies were obtained and analyzed.

RESULTS:

The search strategy identified 867 potential articles, of which 86 were reviewed at the full-text level and 10 met criteria for inclusion. The sensitivity, specificity, positive predictive value, and negative predictive values of ULTE4 to determine aspirin intolerance in subjects with asthma were 0.55, 0.82, 0.75, and 0.66 (Amersham-enzyme immunoassay); 0.76, 0.77, 0.70, and 0.78 (Cayman-enzyme immunoassay); 0.70, 0.81, 0.86, and 0.79 (mass spectrometry); and 0.81,0.79, 0.65, and 0.88 (radioimmunoassay) at optimal thresholds of 192, 510, 167 to 173, and 66 to 69 pg/mg Cr, respectively. The diagnostic odds ratio for each methodology was 6.0, 11.9, 10.5, and 19.1, respectively.

CONCLUSIONS:

ULTE4 is a marker for aspirin-intolerant asthma and could potentially be used as a clinical test to identify the risk of aspirin intolerance in subjects with asthma.

KEYWORDS:

Aspirin intolerance; Aspirin-exacerbated respiratory disease; Asthma; Chronic rhinosinusitis; Corticosteroids; Nasal polyps; Urinary leukotriene E4

PMID:
28202405
DOI:
10.1016/j.jaip.2016.11.004
[Indexed for MEDLINE]

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