Sinus surgery is associated with a decrease in aspirin-induced reaction severity in AERD patients.

BACKGROUND: Nasal polyps influence the burden of aspirin-exacerbated respiratory disease (AERD) by contributing to eicosanoid production. AERD is diagnosed through graded aspirin challenges. It is not known how sinus surgery affects aspirin challenge outcomes. OBJECTIVE: To investigate the effects of endoscopic sinus surgery (ESS) on aspirininduced reaction severity and on the levels of eicosanoids associated with these reactions. METHODS: Twentyeight patients with AERD were challenged with aspirin before and 3 to 4 weeks after ESS. Respiratory parameters and plasma and urine levels of eicosanoids were compared before and after challenges. RESULTS: Before ESS, AERDdiagnosiswas confirmed in all study patients by aspirin challenges that resulted in hypersensitivity reactions. After ESS, reactions to aspirin were less severe in all patients and 12 of 28 patients (43%, P <.001) had no detectable reaction. A lack of clinical reaction to aspirin was associated with lower peripheral blood eosinophilia (0.1 K/mL [interquartile range (IQR) 0.10.3] vs 0.4 K/mL [IQR 0.20.8]; P[. 006), lower urinary leukotriene E4 levels after aspirin challenge (98 pg/mg creatinine [IQR 61239] vs 459 pg/mg creatinine [IQR 1411344]; P= . 02), and lower plasma prostaglandin D2 to prostaglandin E2 ratio (0 [0] vs 0.43 [0.2]; P=. 03), compared with those who reacted. CONCLUSIONS: Sinus surgery results in decreased aspirin sensitivity and a decrease in several plasma and urine eicosanoid levels in patients with AERD. Diagnostic aspirin challenges should be offered to patients with suspected AERD before ESS to increase diagnostic accuracy. Patientswith establishedAERDcould undergo aspirin desensitizations after ESS as the severity of their aspirininduced hypersensitivity reactions lessens. (C) 2018 American Academy of Allergy, Asthma & Immunology