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Individual Monitoring of Aspirin Desensitization
Jan Gosepath, MD;
Dirk Schaefer, MS;
Ronald G. Amedee, MD;
Wolf J. Mann, MD
Arch Otolaryngol Head Neck Surg. 2001;127:316-321.
Background Patients with aspirin-sensitive rhinosinusitis, which is frequently
associated with intrinsic bronchial asthma, can be desensitized by long-term
treatment with oral aspirin. The exact mechanisms of this desensitization
remain obscure, but modulations of the eicosanoid pathway occur and can be
monitored with the help of a practicable in vitro assay on mixed leukocyte
cultures.
Objective To monitor the effect of low-dose aspirin desensitization therapy, 100
mg/d, objectively by an in vitro assay.
Design In a prospective study, 30 patients with aspirin intolerance, who were
treated following a desensitization protocol with a dose of oral aspirin of
only 100 mg/d were followed up for 1 year and reassessed every 3 months clinically
and in vitro.
Results Twenty-five patients showed a normalization of in vitro eicosanoid levels
during this period, 4 showed some improvement, and 1 showed no therapeutic
effect on eicosanoid release. Clinical follow-up revealed a low recurrence
rate of nasal polyposis, with recurrent disease only in 4 individuals who
also showed no normalization of eicosanoid release levels. Furthermore, a
reduction of the average incidence of purulent episodes of sinusitis was seen
after 1 year. Of 12 patients with asthma, 9 experienced marked improvement
in pulmonary function. Of 16 individuals with a marked impairment of nasal
breathing, 14 felt an increase of nasal patency, and 7 of 11 patients with
pretreatment hyposmia had an improved sense of smell after 1 year.
Conclusions Desensitization therapy in patients with aspirin-sensitive rhinosinusitis
can be successfully performed with low oral doses of aspirin, and the individual
course throughout the desensitization can be monitored with the help of an
in vitro analysis of eicosanoid release from mixed leukocyte cultures.
From the Departments of Otolaryngology–Head and Neck Surgery,
Mainz Medical School, Mainz, Germany (Drs Gosepath and Mann and Mr Schaefer);
and Tulane University, School of Medicine, New Orleans, La (Dr Amedee).
Corresponding author and reprints: Jan Gosepath, MD, Department of
Otolaryngology–Head and Neck Surgery, Mainz Medical School, Langenbeckstrasse
1, 55101 Mainz, Germany (e-mail: gosepath{at}hno.klinik.uni-mainz.de).
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