A Review of Aspirin-exacerbated Respiratory Diseases and Immunological Efficacy of Aspirin Desensitization

Hossein Esmaeilzadeh; Maryam Zare; Soheila Alyasin; Hesamedin Nabavizadeh; Negar Mortazavi; Zahra Kanannejad

doi:10.18502/ijaai.v21i5.11039

Hossein Esmaeilzadeh Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
Maryam Zare Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Soheila Alyasin Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
Hesamedin Nabavizadeh Department of Allergy and Clinical Immunology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
Negar Mortazavi Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
Zahra Kanannejad Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

DOI: https://doi.org/10.18502/ijaai.v21i5.11039

Keywords: Aspirin-exacerbated respiratory disease; Aspirin desensitization; Immune responses; Inflammations; Leukotrienes

Abstract

Aspirin-exacerbated respiratory disease (AERD) is a chronic inflammatory disease. It is defined by asthma, chronic rhinosinusitis with nasal polyposis, and a hypersensitivity reaction to aspirin or nonsteroidal anti-inﬂammatory drugs. Aspirin desensitization (AD) has been confirmed as an effective treatment to control AERD inflammation through the modulation of immune responses. We aimed to review AERD with an overview of the epidemiology, pathophysiology, and treatment. We also discussed the effect of AD on immunological markers involved in AERD pathogenesis. A search of electronic databases on AERD was performed. We included five randomized clinical trials (RCTs) on AD. We also searched databases for recent studies that investigated the effect of AD on the immunological mechanisms of AERD. RCTs have demonstrated the therapeutic effectiveness of AD on the patients’ quality of life, asthma symptom score, inhaled and oral steroid use, forced expiratory volume in 1 sec (FEV1), and inflammatory mediators. The clinical benefits of AD can occur though the regulation of innate and adaptive immune responses that are involved in the pathogenesis of AERD. In addition to the valuable effects of AD in RCTs, some side effects such as gastrointestinal bleeding, asthma exacerbation, or rash have been reported that should be considered for reaching an optimal protocol for AD.