Występowanie nadwrażliwości na aspirynę u chorych na przewlekły nieżyt nosa i zapalenie zatok przynosowych oraz wartość diagnostyczna pomiaru leukotrienu $E_{4}$ w moczu
| Autor: | Marek Sanak, Krzysztof Oleś, Paweł Stręk, Karolina Hydzik-Sobocińska, Krzysztof Wojcik, Joanna Szaleniec, Natalia Celejewska-Wójcik, Lucyna Mastalerz, Rafał Nieckarz, Agnieszka Cybulska, Patryk Hartwich, Rafał Januszek |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Pathology leukotriene $E_{4}$ przewlekłe zapalenie zatok Placebo Gastroenterology leukotrien $E_{4}$ Drug Hypersensitivity chemistry.chemical_compound Internal medicine astma chronic sinusitis otorhinolaryngologic diseases Internal Medicine medicine Humans Sinusitis Nose Asthma Rhinitis aspirin hypersensitivity Leukotriene E4 Aspirin business.industry Functional endoscopic sinus surgery asthma Middle Aged medicine.disease medicine.anatomical_structure chemistry Otorhinolaryngology Chronic Disease Female business nadwrażliwość na aspirynę medicine.drug |
| Zdroj: | Scopus-Elsevier |
| Popis: | INTRODUCTION Chronic rhinosinusitis (CRS) with nasal polyposis (NP) may be associated with hypersensitivity to nonsteroidal anti-inflammatory drugs, representing a syndrome of aspirin-exacerbated respiratory disease (AERD). OBJECTIVES The aim of the study was to validate a simple measurement of urinary leukotriene E4 (uLTE4) excretion for the diagnosis of AERD in patients with CRS and indication for surgery. PATIENTS AND METHODS Subjects requiring functional endoscopic sinus surgery (FESS) were recruited from the Department of Otolaryngology (n = 24). Before surgery, a standard oral placebo-controlled aspirin challenge was performed to diagnose aspirin hypersensitivity. Urine samples were collected on the placebo day and both before and within 2 to 4 hours after aspirin challenge for uLTE4 measurement. RESULTS All patients with CRS had sinusitis confirmed by computed tomography. Previous ear, nose, and throat surgery was performed in 70% of the patients, NP was present in 86%, and asthma was diagnosed in 62.5%. AERD was diagnosed in 8 subjects (7 women and 1 man). Five of those patients had bronchoconstriction. At baseline, median uLTE4 was 7.5-times higher in AERD subjects than in the remaining patients. It increased almost 6-fold following the challenge, while remained unchanged in patients without aspirin hypersensitivity. Pretest uLTE4 had a sensitivity of 87.5% and specificity of 93.75% to diagnose aspirin hypersensitivity in patients with CRS. After the challenge, the values improved to 100% sensitivity and 93% specificity. CONCLUSIONS Among CRS subjects requiring FESS, as many as 33.3% may have AERD and respond to a small provocative dose of aspirin with bronchoconstriction and/or mucosal and skin edema. A simple and inexpensive measurement of uLTE4 can help diagnose AERD in patients with CRS with sensitivity of 87.5%, but its specificity is limited and depends on the arbitrary threshold of uLTE4. |
| Databáze: | OpenAIRE |
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