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The incidence of aspirin hypersensitivity in chronic rhinosinusitis patients and diagnostic value of urinary LTE4.
MedLine Citation:
PMID:  22814420     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION Chronic rhinosinusitis (CRS) with nasal polyposis (NP) may associate with aspirin hypersensitivity, presenting the syndrome of aspirin-exacerbated respiratory disease (AERD). OBJECTIVES The aim of this study was to validate a simple measurement of uLTE4 excretion for diagnostics of AERD in patients with CRS before surgery.  PATIENTS AND METHODS Subjects requiring functional endoscopic sinuses surgery (FESS) were enrolled to the study at the Department of Otolaryngology (n=24). Before surgery, a standard oral placebo controlled aspirin challenge was done to diagnose AERD. Urine samples were collected on the placebo day and both before and within 2-4 hours after aspirin challenge for leukotriene E4 (uLT4) measurement.  RESULTS All CRS patients had sinusitis confirmed by CT. In 70% they experienced previous ENT surgery, 86% presented NP, 62.5% had physicians diagnosed asthma. AERD was diagnosed in 8 subjects (1 male), 5 had bronchoconstriction. Median uLTE4 at base was 7.5 times higher in AERD subjects and further increased almost 6-fold following the challenge, while remained unchanged in other CRS subjects. Pre-test uLTE4 had a limited 87.5% sensitivity and specificity approaching 93.75% specificity to diagnose AERD within CRS patients. Diagnostic value improved to 100% sensitivity and 93% specificity when post-challenge uLTE4 was measured. CONCLUSIONS Among CRS subjects requiring FESS as much as 33.3% have AERD and respond to a small provocative dose of aspirin with bronchoconstriction and/or mucosal and skin edema. A simple and inexpensive measurement of urinary LTE4 can help in AERD diagnosis by a correct identification of 87.5% aspirin-sensitive CRS subjects but its specificity depends on arbitrary set threshold of uLTE4. 
Authors:
Natalia Celejewska-Wójcik; Lucyna Mastalerz; Krzysztof Wójcik; Rafał Nieckarz; Rafał Januszek; Patryk Hartwich; Joanna Szaleniec; Karolina Hrydzik-Sobocińska; Krzysztof Oleś; Agnieszka Cybulska; Paweł Stręk; Marek Sanak
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-19
Journal Detail:
Title:  Polskie Archiwum Medycyny Wewnetrznej     Volume:  -     ISSN:  1897-9483     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401225     Medline TA:  Pol Arch Med Wewn     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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