Category: Drug Allergy > Topics for Medical Professionals  

Aspirin Exacerbated Respiratory Disease

What is Aspirin Triad Asthma (also known as AIA-Aspirin intolerant Asthma)?

Aspirin-intolerant asthma (AIA) is a specific subtype of asthma. It is characterized by asthmatic episodes triggered within 1-3 hours of taking an aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). There also often rhinitis symptoms (nasal congestion, runny nose and sneezing) and facial flushing. The asthma attack triggered by aspirin may be very severe and life threatening.

The syndrome of Aspirin Triad Asthma is different from other forms of asthma. It starts later in life, usually after age 30. The syndrome starts with nasal symptoms including congestion, and sneezing, runny nose and diminished or loss of a sense of smell. The lining of the nose swells and nasal polyps develop. On average, asthma develops two years after the onset of nasal symptoms, with intolerance to aspirin and other NSAIDs occurring about four years later. Sinus infections are very common in those with significant nasal obstruction.

Patients with Aspirin Intolerant Asthma may be unaware of their intolerance to aspirin. They may have taken aspirin or NSAIDS in the past, before onset of this syndrome, without any problem. However, as opposed to other types of allergies, the development of aspirin-induced asthma does not depend on having had previous exposure to aspirin or NSAIDs. Although avoidance of all NSAIDS is important to prevent acute attacks, the condition tends to be progressive, despite avoidance of these medications. Diet does not help.

What Causes Aspirin Triad Asthma?

The cause is unknown but overproduction of leukotrienes occurs at baseline in these patients and this is increased even further with aspirin/NSAID ingestion. Taking aspirin activates allergic cells in the lungs and sinuses of patients with aspirin-triad asthma.

Treatment Options:

Leukotriene modifiers which block the effects of leukotrienes certainly diminish the symptoms induced by aspirin in those with aspirin triad asthma. Since these patients produce an abundance of leukotrienes at baseline some, but not all, experience mild improvement in their nasal and asthma symptoms. Ironically, though taking a full dose of NSAIDs will cause an acute attack in an aspirin triad asthma patient, slow aspirin desensitization has proven to be one of the most effective treatments. This should only be done under close physician supervision.

Some things to know about Aspirin-Induced Asthma:

  • Tends to develop in the more severe asthma patients
  • Aspirin may induce life-threatening asthma attacks

Other Terms for Aspirin-Induced Asthma (AIA)

  • Aspirin-sensitive asthma
  • Aspirin-intolerant asthma
  • NSAID-induced rhinitis and asthma

****There is a long list of medications to look out for. See this site for a comprehensive list of NSAIDs. NSAIDs are also in many common drugs (eg-Alka Seltzer).  Rarely even acetominaphen and selective COX2 inhibitors cause asthmatic reactions due to week inhibition of Cox-1 ****

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