Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, Minn.
Department of International Medicine Programs, The George Washington University School of Medicine and Health Sciences, Washington, DC.
J Allergy Clin Immunol Pract. 2023 Dec;11(12):3662-3669.e2. doi: 10.1016/j.jaip.2023.07.035. Epub 2023 Aug 2.
Nonsteroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (N-ERD) has a triad of symptoms: nasal polyposis, asthma, and NSAID hypersensitivity. Little is known about symptom timing and disease progression.
The aim of this study is to characterize disease progression in N-ERD.
Patients with N-ERD were prospectively interviewed and classified into 4 groups based on their first symptom at initial N-ERD onset (asthma, nasal polyps, NSAID hypersensitivity, or all concurrently). Associations of patient characteristics with the 4 groups were examined, along with associations within the "asthma first" group.
Patients (N = 240) were mostly female (68%) and self-identified as non-White (77%). Half (N = 119) reported asthma as the earliest symptom in the N-ERD triad. Compared with other groups, "asthma first" was associated with younger age of onset (25 years, standard error ±1.3, P < .001) and higher body mass index (BMI) (odds ratio [OR] = 1.3, 95% confidence interval [CI]: 1.06-1.7, P = .02). In this group, age of onset <20 years was associated with female sex, Latino ethnicity, and higher BMI (all P < .05). The "NSAID sensitivity first" group was significantly associated with male sex (OR = 3.3, 95% CI: 1.5-7.4, P = .004) and pollution exposure (OR = 4.4, 95% CI: 1.6-11.9, P = .003). At the initial presentation, 27% of patients were unaware of their N-ERD diagnosis. Black and Latino patients were more likely to be unaware of their N-ERD diagnosis compared with White (P = .003). The median diagnostic delay was 3 years (interquartile range: 0-5 years).
In this cohort, N-ERD is highly variable in onset and progression, with sex, BMI, race and ethnicity, and environmental exposures significantly associated with disease patterns and diagnostic delay.
非甾体抗炎药（NSAID）加重的呼吸道疾病（N-ERD）有三联征：鼻息肉、哮喘和 NSAID 过敏。关于症状出现的时间和疾病进展知之甚少。
本研究旨在描述 N-ERD 的疾病进展。
前瞻性访谈 N-ERD 患者，并根据首次出现 N-ERD 时的首发症状（哮喘、鼻息肉、NSAID 过敏或同时出现）将患者分为 4 组。研究了患者特征与 4 组之间的关联，以及“哮喘首发”组内的关联。
患者（N=240）大多为女性（68%），自我认定为非白人（77%）。一半（N=119）报告哮喘是 N-ERD 三联征中最早出现的症状。与其他组相比，“哮喘首发”与发病年龄较小（25 岁，标准误差±1.3，P<.001）和较高的体重指数（BMI）（比值比[OR]为 1.3，95%置信区间[CI]：1.06-1.7，P=.02）相关。在该组中，发病年龄<20 岁与女性、拉丁裔种族和较高的 BMI 相关（均 P<.05）。“NSAID 过敏首发”组与男性（OR=3.3，95%CI：1.5-7.4，P=.004）和污染暴露（OR=4.4，95%CI：1.6-11.9，P=.003）显著相关。在初次就诊时，27%的患者不知道自己的 N-ERD 诊断。与白人相比，黑人患者和拉丁裔患者更有可能不知道自己的 N-ERD 诊断（P=.003）。中位诊断延迟时间为 3 年（四分位间距：0-5 年）。
在本队列中，N-ERD 的发病和进展具有高度变异性，性别、BMI、种族和民族以及环境暴露与疾病模式和诊断延迟显著相关。
