Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-12-01T03:21:41.486Z Has data issue: false hasContentIssue false
  • English
  • Français

Intranasal lysine-aspirin administration decreases polyp volume in patients with aspirin-intolerant asthma

Published online by Cambridge University Press:  15 August 2007

N Ogata ,
Y Darby  and
G Scadding
N Ogata
Affiliation:
Department of Rhinology, Royal National Throat, Nose and Ear Hospital, London, UK Department of Otolaryngology, Kumamoto Medical Center, Kumamoto, Japan
Y Darby
Affiliation:
Department of Otolaryngology, Kumamoto Medical Center, Kumamoto, Japan
G Scadding*
Affiliation:
Department of Rhinology, Royal National Throat, Nose and Ear Hospital, London, UK
*
Address for correspondence: Dr Glenis Scadding, Royal National Throat, Nose, and Ear Hospital, Grays Inn Road, London WC1X 8DA, UK. Fax: +44 20 7833 5518 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Nasal polyposis associated with aspirin-intolerant asthma tends to be difficult to control, with frequent recurrences. We examined the effect of intranasal lysine-aspirin administration on resistant nasal polyps of asthmatic, aspirin-intolerant patients, when used in addition to routine therapy.

Patients and methods:

Thirteen patients with asthma and intolerance to aspirin were recruited. All but one had undergone numerous polypectomies and were uncontrolled on standard therapy with intranasal corticosteroids, leukotriene receptor antagonists and nasal douching. Aspirin treatment involved one drop (100 µl) of 30 mg/ml lysine-aspirin solution to each nostril, initially daily, increased every two or three days up to a maximal of 18 drops (54 mg lysine-aspirin) a day. Nasal symptoms, nitric oxide level, nasal inspiratory peak flow rate, peak expiratory flow rate and nasendoscopic grading were assessed prior to therapy and three months later. We also compared the change in endoscopic polyp scores during three months of lysine-aspirin administration with the changes which had occurred during the three months prior to administration (during which time other therapies had been identical).

Results:

Nasal blockage symptoms tended to decrease; other nasal symptoms were unchanged. Significant changes were seen in nasal inspiratory peak flow rate (103.3 ± 18.9 and 140.0 ± 16.7 l/min before and after aspirin, respectively; p = 0.014), but not in peak expiratory flow rate (438.7 ± 33.4 and 440.0 ± 28.4 l/min before and after aspirin, respectively; p = 0.700). Nasal nitric oxide levels rose significantly (in both sides, p = 0.028). Expired chest nitric oxide levels did not change. Nasal polyp scores on nasendoscopic examination were significantly reduced (right side, p = 0.027; left side, p = 0.018). Compared with the preceding three months, adding intranasal lysine-aspirin application had the effect on decreasing nasal polyp volume (right side, p = 0.031; left side, p = 0.016).

Conclusion:

This open study suggests that intranasal lysine-aspirin administration reduces nasal polyp volume in aspirin-intolerant patients, without any adverse affect on concomitant asthma. This was a preliminary study and should be followed by a placebo-controlled, double-blind trial.

Keywords

Nasal PolypAspirinLysine-AcetylsalicylateAsthma
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 121 , Issue 12 , December 2007 , pp. 1156 - 1160
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Samter, M, Beers, RF. Intolerance to aspirin: clinical studies and consideration of its pathogenesis. Ann Intern Med 1968;68:875–83CrossRefGoogle ScholarPubMed
2 Settipane, GA, Klein, DE, Settipane, RJ. Nasal polyps, state of the art. Rhinology 1991;11:33–6Google ScholarPubMed
3 Kowalski, ML. Management of aspirin-sensitive rhinosinusitis asthma syndrome: what role for aspirin desensitization? Allergy Proc 1992;13:175–84CrossRefGoogle ScholarPubMed
4 Szczeklik, A, Gryglewski, RJ, Czerniawska-Mysik, G. Relationship of inhibition of prostaglandin biosynthesis by analgesics to asthma attacks in aspirin-sensitive patients. BMJ 1975;1:67–9CrossRefGoogle ScholarPubMed
5 Ragab, S, Parikh, A, Darby, YC, Scadding, GK. An open audit of montelukast, a leukotriene receptor antagonist, in nasal polyposis associated with asthma. Clin Exp Allergy 2001;31:1385–91CrossRefGoogle ScholarPubMed
6 Zeiss, CR, Lockey, RF. Refractory period to aspirin in a patient with aspirin-induced asthma. J Allergy Clin Immunol 1976;57:440–8CrossRefGoogle Scholar
7 Berges-Gimeno, MP, Simon, RA, Stevenson, DD. Long-term treatment with aspirin desensitization in asthmatic patients with aspirin-exacerbated respiratory disease. Allergy Clin Immunol 2003;111:180–6CrossRefGoogle ScholarPubMed
8 Stevenson, DD, Hankammer, MA, Mathison, DA, Christiansen, SC, Somon, RA. Aspirin desensitization treatment of aspirin-sensitive patients with rhinosinusitis-asthma: long-term outcomes. J Allergy Clin Immunol 1996;98:751–8CrossRefGoogle ScholarPubMed
9 Sousa, AR, Parikh, A, Scadding, GK, Corrigan, C, Lee, TH. Leukotriene-receptor expression on nasal mucosal inflammatory cells in aspirin-sensitive rhinosinusitis. N Engl J Med 2002;347:1493–9CrossRefGoogle ScholarPubMed
10 Parikh, A, Scadding, GK. Intranasal lysine-aspirin in aspirin-sensitive nasal polyposis: a controlled trial. Laryngoscope 2005;115:1385–90CrossRefGoogle ScholarPubMed
11 Holmstrom, M, Scadding, GK, Lund, VJ, Darby, YC. Assessment of nasal obstruction: a comparison between rhinomanometry and nasal inspiratory peak flow. Rhinology 1990;28:191–6Google ScholarPubMed
12 Kharitonov, S, Alving, K, Barnes, PJ. Exhaled and nasal nitric oxide measurements recommendations. Eur Respir J 1997;10:1683–93CrossRefGoogle ScholarPubMed
13 Lund, VJ, Mackay, IS. Staging in rhinosinusitis. Rhinology 1993;31:183–4Google Scholar
14 Patriarca, G, Schiavino, D, Nucera, E, Papa, G, Shico, G, Fais, G. Prevention of relapse in nasal polyposis. Lancet 1991;337:1488CrossRefGoogle ScholarPubMed
15 Nucera, E, Schiavino, D, Milani, A, DelNinno, M, Misuraca, C, Buonomo, A et al. Effects of lysine-acetylsalicylate (LAS) treatment in nasal polyposis: two controlled long term prospective follow up studies. Thorax 2000;55(suppl 2):S75–8CrossRefGoogle ScholarPubMed
16 Scadding, GK, Hassab, M, Darby, YC, Lund, VJ, Freeman, A. Intranasal lysine aspirin in recurrent nasal polyposis. Clin Otolaryngol 1995;20:561–3CrossRefGoogle ScholarPubMed
17 Colantonio, L, Brouillette, L, Parikh, A, Scadding, GK. Paradoxical low nasal nitric oxide in nasal polyposis. Clin Exp Allergy 2002;32:698–701CrossRefGoogle ScholarPubMed
18 Juergens, UR, Christiansen, SC, Stevenson, DD, Zuraw, BL. Inhibition of monocyte leukotriene B4 production after aspirin desensitization. J Allergy Clin Immunol 1995;96:148–56CrossRefGoogle ScholarPubMed
19 Bruzzese, N, Sica, G, Iacopino, F, Paludetti, G, Schiavino, D, Nucera, E et al. Growth inhibition of fibroblasts from nasal polyps and normal skin by lysine acetylsalicylate. Allergy 1998;53:431–4CrossRefGoogle ScholarPubMed
20 Sweet, JA, Stevenson, DD, Simon, RA, Mathison, DA. Long term effects of aspirin desensitization treatment for aspirin sensitive rhinosinusitis asthma. J Allergy Clin Immunol 1990;86:59–65CrossRefGoogle Scholar