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J Allergy Clin Immunol Pract. 2018 Dec 21. pii: S2213-2198(18)30836-5. doi: 10.1016/j.jaip.2018.12.014. [Epub ahead of print]

Sinus Surgery Is Associated with a Decrease in Aspirin-Induced Reaction Severity in Patients with Aspirin Exacerbated Respiratory Disease.

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Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY. Electronic address:
National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle, NC.
Albert Einstein College of Medicine, Bronx, NY.
Cayman Chemical Inc., Ann Arbor, Mich.
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
Washington University School of Medicine, St. Louis, Mo.



Nasal polyps influence the burden of aspirin-exacerbated respiratory disease (AERD) by contributing to eicosanoid production. AERD is diagnosed through graded aspirin challenges. It is not known how sinus surgery affects aspirin challenge outcomes.


To investigate the effects of endoscopic sinus surgery (ESS) on aspirin-induced reaction severity and on the levels of eicosanoids associated with these reactions.


Twenty-eight patients with AERD were challenged with aspirin before and 3 to 4 weeks after ESS. Respiratory parameters and plasma and urine levels of eicosanoids were compared before and after challenges.


Before ESS, AERD diagnosis was confirmed in all study patients by aspirin challenges that resulted in hypersensitivity reactions. After ESS, reactions to aspirin were less severe in all patients and 12 of 28 patients (43%, P < .001) had no detectable reaction. A lack of clinical reaction to aspirin was associated with lower peripheral blood eosinophilia (0.1 K/μL [interquartile range (IQR) 0.1-0.3] vs 0.4 K/μL [IQR 0.2-0.8]; P = .006), lower urinary leukotriene E4 levels after aspirin challenge (98 pg/mg creatinine [IQR 61-239] vs 459 pg/mg creatinine [IQR 141-1344]; P = .02), and lower plasma prostaglandin D2 to prostaglandin E2 ratio (0 [±0] vs 0.43 [±0.2]; P = .03), compared with those who reacted.


Sinus surgery results in decreased aspirin sensitivity and a decrease in several plasma and urine eicosanoid levels in patients with AERD. Diagnostic aspirin challenges should be offered to patients with suspected AERD before ESS to increase diagnostic accuracy. Patients with established AERD could undergo aspirin desensitizations after ESS as the severity of their aspirin-induced hypersensitivity reactions lessens.


Aspirin challenges; Aspirin-exacerbated respiratory disease; Eicosanoids; Endoscopic sinus surgery; Eosinophils; Nasal polyps


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