Systematic review of outcomes for endoscopic sinus surgery and subsequent aspirin desensitization in aspirin-exacerbated respiratory disease

Background: Aspirin therapy and/or type 2 (T2) biologics are used in the management of aspirin-exacerbated respiratory disease (AERD). Objective: To identify the number of patients with AERD who tolerated aspirin therapy, yet due to persistent symptoms, incorporated T2 biologic management. Methods: A retrospective review was performed between July 2016 and June 2019. Patients with AERD and who underwent endoscopic sinus surgery (ESS), aspirin desensitization (AD), and at least 6 months of aspirin therapy (ATAD) after AD, and who remained biologic-naive up through this timepoint were included in the study. Introduction of a T2 biologic while on ATAD was the primary outcome. The secondary outcome was a change in a validated patient-reported outcome measure for chronic rhinosinusitis score between the postoperative predesensitization timepoint, and the 6-month postdesensitization timepoint, presented as means and compared by using the Student's t-test. Results: A total of 103 patients met inclusion criteria. Two patients (1.9%) ultimately supplemented ATAD with a T2 biologic. The mean outcomes measure test score after 6 months of ATAD for patients who received biologics was 40.5 versus 15 in those who did not receive biologics (p = 0.02). The mean differences between the postoperative predesensitization test score and the 6-month postdesensitization test score for patients who went on to receive biologics was an increase of 13 versus a decrease of 10 for those patients who did not receive biologics (p = 0.12). Conclusion: ESS, coupled with AD and ATAD, was successful in the long-term management of the majority of the patients with AERD, which rarely required the incorporation of T2 biologics. Patient questionnaires, such as outcomes measure test score, may identify aspirin therapy failures and help guide the practitioner in deciding when to introduce T2 biologics into the patient's treatment regimen.

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Allergic Rhinitis and Aspirin-Exacerbated Respiratory Disease as Predictors of the Olfactory Outcome after Endoscopic Sinus Surgery

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2009.23.3325 ◽

2009 ◽

Vol 23 (3) ◽

pp. 348-353 ◽

Cited By ~ 28

Author(s):

Michael Katotomichelakis ◽

Maria Riga ◽

Spyridon Davris ◽

Gregorios Tripsianis ◽

Maria Simopoulou ◽

...

Keyword(s):

Allergic Rhinitis ◽

Respiratory Disease ◽

Endoscopic Sinus Surgery ◽

Nasal Polyposis ◽

Sinus Surgery ◽

Olfactory Acuity ◽

Aspirin Exacerbated Respiratory Disease ◽

Negative Effect ◽

Time Frames

Background Unlike the functional outcomes of endoscopic sinus surgery, which have been thoroughly studied, the effect of the surgery on olfactory performance and the relative predictive factors have not been adequately assessed by literature. Allergic rhinitis and aspirin-exacerbated respiratory disease (AERD) are examined as potential confounding factors of the olfactory outcome in patients with extensive nasal polyposis and rhinosinusitis treated with functional endoscopic sinus surgery (FESS). Methods A population of 116 adults with severe nasal polyposis was subjected to FESS after failure of the appropriate medical treatment. The olfactory outcome was quantified by Sniffin’ Sticks at the 1st, 3rd, and 6th postoperative month in relation to the concomitant presence of allergic rhinitis (n = 62) or AERD (n = 18). Results Allergic patients seemed to perform worse than nonallergic patients at all time frames. However, when patients with similar olfactory acuity, age, and medical history are compared, allergic rhinitis does not seem to affect the postoperative improvement of the composite threshold-discrimination-identification scores. The same seems to apply for the likelihood of acquiring normosmia after surgery. On the contrary, AERD significantly limits the recovery of olfactory function at all follow-up examinations and patients with AERD are unlikely to become normosmic. Conclusion The olfactory recovery after FESS for nasal polyposis is significantly affected by the concomitant presence of AERD. Although allergy seems to have a general negative effect on olfactory acuity, it was not found to affect the extent of the olfactory improvement, when patients with comparable preoperative characteristics are addressed.

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Endoscopic sinus surgery improves aspirin treatment response in aspirin‐exacerbated respiratory disease patients

International Forum of Allergy & Rhinology ◽

10.1002/alr.22418 ◽

2019 ◽

Vol 9 (12) ◽

pp. 1401-1408 ◽

Cited By ~ 8

Author(s):

Sharan J. Shah ◽

Waleed M. Abuzeid ◽

Anusha Ponduri ◽

Teresa Pelletier ◽

Zhen Ren ◽

...

Keyword(s):

Treatment Response ◽

Respiratory Disease ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Aspirin Exacerbated Respiratory Disease

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Aspirin desensitization for aspirin-exacerbated respiratory disease (Samter's Triad): a systematic review of the literature

International Forum of Allergy & Rhinology ◽

10.1002/alr.21202 ◽

2013 ◽

Vol 3 (11) ◽

pp. 915-920 ◽

Cited By ~ 30

Author(s):

Jason J. Xu ◽

Leigh Sowerby ◽

Brian W. Rotenberg

Keyword(s):

Systematic Review ◽

Respiratory Disease ◽

Review Of The Literature ◽

Aspirin Desensitization ◽

Aspirin Exacerbated Respiratory Disease ◽

Samter’S Triad

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Aspirin desensitization therapy in aspirin‐exacerbated respiratory disease: a systematic review

International Forum of Allergy & Rhinology ◽

10.1002/alr.22520 ◽

2020 ◽

Vol 10 (4) ◽

pp. 450-464 ◽

Cited By ~ 7

Author(s):

Natasha Larivée ◽

Christopher J. Chin

Keyword(s):

Systematic Review ◽

Respiratory Disease ◽

Aspirin Desensitization ◽

Aspirin Exacerbated Respiratory Disease ◽

Desensitization Therapy

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Long-term Clinical Outcomes of Aspirin Desensitization With Continuous Daily Aspirin Therapy in Aspirin-exacerbated Respiratory Disease

American Journal of Rhinology and Allergy ◽

10.1177/1945892418770260 ◽

2018 ◽

Vol 32 (4) ◽

pp. 280-286 ◽

Cited By ~ 23

Author(s):

Kristen M. Walters ◽

Jeremy D. Waldram ◽

Katharine M. Woessner ◽

Andrew A. White

Keyword(s):

Respiratory Disease ◽

Average Length ◽

Airway Disease ◽

Sinus Surgery ◽

Response To Treatment ◽

Aspirin Desensitization ◽

Aspirin Exacerbated Respiratory Disease ◽

Systemic Corticosteroids ◽

Samter’S Triad

Background Aspirin-exacerbated respiratory disease (AERD), also known as Samter’s triad or aspirin (ASA)-intolerant asthma, affects 7% of asthmatics and has a higher prevalence in those with chronic rhinosinusitis and concomitant nasal polyposis. ASA desensitization with daily ASA therapy is a uniquely beneficial treatment for this disease entity and has been shown to have a significant impact on symptom scores, polyp disease, and need for systemic corticosteroids. However, no long-term studies have demonstrated whether or not ASA therapy remains safe and beneficial for these patients beyond 5–10 years. Objective This study was designed to determine the clinical course of AERD patients desensitized between 1995 and 2010. Methods A 20-question survey was distributed to patients who successfully completed ASA desensitization between January 1995 and April 2010. The questions were designed to assess ASA safety and longitudinal effects of ASA therapy in AERD. Results Of the 285 patients contacted, 92 (32%) completed the questionnaire. Average length of follow-up was 15 years. Of survey responders, 35 patients had discontinued ASA therapy. Although adverse reactions occurred, many also discontinued due to lack of efficacy or need for surgery. For those remaining on ASA (62%), significant improvement in sense of smell, asthma, sinus, and allergic rhinitis scores were noted ( P ≤ .001). The majority of ASA patients (68%) had a positive response to treatment and did not require further sinus surgery. However, ASA therapy did not delay the time to next sinus/polyp surgery ( P = .27) or reduce total number of sinus surgeries ( P = .56) compared to those who stopped treatment. Nearly 85% of AERD patients on ASA therapy found it to be helpful in improving airway disease and quality of life. Conclusion Aspirin desensitization followed by daily maintenance ASA therapy appears to be safe and effective even after 10+ years of continuous use.

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