Pfaar Oliver, Klimek Ludger
Center for Allergy and Rhinology, Wiesbaden, Germany.
Curr Opin Allergy Clin Immunol. 2006 Jun;6(3):161-6. doi: 10.1097/01.all.0000225153.45027.6a.
This review provides an overview of sensitivity to aspirin (acetylsalicylic acid) and its management. In particular, it focuses on current standards and recent improvements in aspirin desensitization. Recent publications on various desensitization protocols and routes of administration are discussed.
The incidence of aspirin hypersensitivity in the general population ranges from 0.6-2.5%, but that in adult asthmatics ranges from 4.3-11%. Carefully controlled challenge tests with aspirin or other non-steroidal anti-inflammatory drugs are performed as the diagnostic tool of choice. Aspirin desensitization therapy has demonstrated therapeutic effects. Various protocols and routes of administration have been elaborated in the last two decades. Oral administration by means of an initial desensitization with incremental doses of aspirin, followed by daily high-dose therapy, has proven clinical efficacy and safety. Immunological mechanisms of aspirin desensitization therapy are also discussed.
The full clinical picture of aspirin intolerance--the association of aspirin-induced bronchial asthma (with severe acute asthma attacks), aspirin sensitivity and nasal polyps--is commonly summarized as the 'Samter triad'. This condition is related to the abnormal metabolism of arachidonic acid, implicating both the lipoxygenase and the cyclooxygenase pathways. Knowledge concerning mechanisms and clinical features of aspirin intolerance has grown rapidly in recent years. Research has focused on new strategies of aspirin desensitization therapy, especially oral administration using high-dosage protocols.
本综述概述了对阿司匹林（乙酰水杨酸）的敏感性及其管理。特别关注阿司匹林脱敏的当前标准和近期进展。讨论了关于各种脱敏方案和给药途径的最新出版物。
普通人群中阿司匹林过敏的发生率为0.6 - 2.5%，但成年哮喘患者中的发生率为4.3 - 11%。使用阿司匹林或其他非甾体抗炎药进行仔细控制的激发试验是首选的诊断工具。阿司匹林脱敏治疗已显示出治疗效果。在过去二十年中已经制定了各种方案和给药途径。通过用递增剂量的阿司匹林进行初始脱敏，然后进行每日高剂量治疗的口服给药方式，已证明具有临床疗效和安全性。还讨论了阿司匹林脱敏治疗的免疫机制。
阿司匹林不耐受的完整临床情况——阿司匹林诱发的支气管哮喘（伴有严重急性哮喘发作）、阿司匹林敏感性和鼻息肉的关联——通常被概括为“桑特三联征”。这种情况与花生四烯酸的异常代谢有关，涉及脂氧合酶和环氧化酶途径。近年来，关于阿司匹林不耐受的机制和临床特征的知识迅速增长。研究集中在阿司匹林脱敏治疗的新策略上，特别是使用高剂量方案的口服给药。
