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The classic syndrome consists of aspirin-induced asthma and nasal
polyps. There are some patients who have extensive nasal polyps
but no asthma and some who have asthma but no sinus trouble but
all of these patients have some form of aspirin sensitivity.
What is Aspirin Triad Asthma?
Aspirin-induced asthma (AIA) is a specific subtype of asthma. It
is characterized by asthma triggered within one to three hours of
ingestion of aspirin and other non-steroidal anti-inflammatory drugs
(NSAIDs). The asthma attack is often accompanied by or even preceded
by symptoms of rhinitis (nasal congestion, runny nose and sneezing)
and facial flushing. The asthma attack triggered by aspirin may
be very severe and life threatening.
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 Sensitive 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?
It is not known what the cause is but overproduction 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, blocking 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 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 can only be done under close
physician supervision in a monitored setting.
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