Ibrahim Christine, Singh Kulraj, Tsai Gina, Huang David, Mazza Jorge, Rotenberg Brian, Kim Harold, Moote David William
Schulich School of Medicine and Dentistry, London, Ontario Canada.
Schulich School of Medicine and Dentistry, London, Ontario Canada ; Department of Allergy and Immunology, London, Ontario Canada.
Allergy Asthma Clin Immunol. 2014 Dec 11;10(1):64. doi: 10.1186/s13223-014-0064-7. eCollection 2014.
Aspirin-exacerbated respiratory disease (AERD), also known as Samter's triad, is a clinical syndrome which consists of aspirin (ASA) intolerance, chronic rhinosinusitis with nasal polyposis, and intrinsic bronchial asthma (Press Med 119:48-51, 1922). ASA challenge is the gold standard for diagnosing AERD (Curr Allergy Asthma 9:155-163, 2009). The practice of ASA challenge and desensitization in Canada is infrequently utilized, which may explain its omission as a viable therapeutic option in the latest Canadian clinical practice guidelines for acute and chronic rhinosinusitis (AACI 7:1-38, 2011).
This retrospective study assessed 111 patients who underwent ASA desensitization in the Allergy and Immunology clinic at St. Joseph's Healthcare (SJHC) in London, Ontario. The mean age was 50.7 years, and 52.5% (n = 58) were male. Sixty-one percent (n = 68) claimed prior, significant reactions to ASA, and all patients had features of AERD.
Seventy-three percent (n = 81) claimed symptom improvement after achieving maintenance dosing on the desensitization protocol. Of this population, 21.6% (n = 24) improved in all 3 areas of interest (sense of taste or smell, upper respiratory symptoms and lower respiratory symptoms). Twenty-six percent (n = 29) had adverse effects, mostly in the way of gastrointestinal upset, but no severe adverse events were seen.
ASA desensitization helps improve symptoms in patients with AERD. Further, it allows patients to tolerate additional ASA and other non-steroidal anti-inflammatories (NSAIDs) when needed for supplemental analgesia or for cardio-protection. This is of particular benefit in those who require these medications for improved quality of life, and for reduced morbidity and mortality, such as those with cardiovascular disease or chronic pain. There should be further studies conducted in Canada as well as consideration for ASA desensitization to be included in the next clinical practice guidelines.
阿司匹林诱发的呼吸道疾病（AERD），也称为桑特三联征，是一种临床综合征，由阿司匹林（ASA）不耐受、伴有鼻息肉的慢性鼻窦炎和内源性支气管哮喘组成（《 Presse Med》119:48 - 51，1922年）。ASA激发试验是诊断AERD的金标准（《 Curr Allergy Asthma》9:155 - 163，2009年）。在加拿大，ASA激发试验和脱敏治疗的应用并不常见，这可能解释了在最新的加拿大急性和慢性鼻窦炎临床实践指南（《 AACI》7:1 - 38，2011年）中，它被遗漏作为一种可行的治疗选择。
这项回顾性研究评估了在安大略省伦敦市圣约瑟夫医疗中心（SJHC）过敏与免疫诊所接受ASA脱敏治疗的111例患者。平均年龄为50.7岁，52.5%（n = 58）为男性。61%（n = 68）称既往对ASA有严重反应，所有患者均有AERD特征。
73%（n = 81）称在脱敏方案达到维持剂量后症状有所改善。在这一群体中，21.6%（n = 24）在所有3个感兴趣的领域（味觉或嗅觉、上呼吸道症状和下呼吸道症状）均有改善。26%（n = 29）出现不良反应，主要是胃肠道不适，但未观察到严重不良事件。
ASA脱敏有助于改善AERD患者的症状。此外，它使患者在需要补充镇痛或心脏保护时能够耐受额外的ASA和其他非甾体抗炎药（NSAIDs）。这对那些需要这些药物来提高生活质量、降低发病率和死亡率的患者，如患有心血管疾病或慢性疼痛的患者特别有益。加拿大应进一步开展研究，并考虑将ASA脱敏纳入下一次临床实践指南。
