Women are twice more likely to be affected by aspirin-induced asthma. Symptoms usually develop gradually over several years [1], but patients with rapid progression have also been described [2]. If patients are atopic, chronic rhinitis and asthma occur earlier in life, unlike aspirin intolerance and nasal polyps [3]. The sense of smell is diminished in these patients [4]. Chronic asthma may have any severity. Even mild, intermittent asthma patients may have acute episodes induced by aspirin consumption and up to one-quarter of patients that need to be admitted to the hospital due to a crisis have ingested non-steroidal anti-inflammatories during the last 3 hours [5]. Respiratory symptoms (wheezing, dyspnea, cough) and chest pain [6] that that radiates to the jaw or arms and is accompanied by diaphoresis and nausea develop together with nasal obstruction or rhinorrhea, periorbital edema, facial flushing or macular rash [7] and conjunctival injection. Less frequently, patients also have abdominal pain, hypotension, and laryngospasm.

If nasal polyps are removed, they tend to recur. Sinus mucosa is also polypoidal and hypertrophied. The initial episode of rhinitis in these patients often occurs after a viral infection [8].

• Inflammation

  BACKGROUND: Interleukin (IL)-4 and IL-6, respectively, markers of neutrophilic and eosinophilic inflammation, were analyzed in nasal and oral exhaled breath condensate to understand the inflammation of upper and lower airways in subjects with aspirin-induced [ncbi.nlm.nih.gov]

  The response of local immunoglobulin E to staphylococcal enterotoxins contributes to eosinophilic inflammation in nasal polyp tissue. [doi.org]

• Pain

  Besides causing symptoms of asthma, aspirin can cause nasal congestion and abdominal pains in susceptible individuals. Most often, this sensitivity to aspirin develops in adulthood. [asthma.partners.org]

  NSAIDs are a group of drugs usually used as pain killers, including ibuprofen and diclofenac. Although paracetamol (acetaminophen) is a generally safe substitute for pain relief, it does have weak cyclooxygenase inhibitory properties. [healthengine.com.au]

  Traditional NSAIDs block an enzyme called COX-1.3 COX-1 has role in pain and inflammation. Therefore, blocking COX-1 relieves pain and reduces inflammation. [asthma.net]

• Fever

  So, if you need to control pain or fever for someone who has an Aspirin and Asthma problem, see the individual pages on Tylenol Side Effects and Ibuprofen Side Effects to get more details. [side-effects-site.com]

  Acetaminophen is the medicine most often used for fever and pain relief for people who cannot take aspirin and NSAIDs. Developed by RelayHealth. Pediatric Advisor 2012.1 published by RelayHealth. [kpjampang.com]

  It is important that people with aspirin sensitivity read labels of all over-the-counter drugs used to treat pain, colds and flu, and fever. Also inform your doctor so that these medications are not prescribed for you. [webmd.com]

  Aspirin, ibuprofen, naproxen and other NSAIDS help stop pain and fever because they block an enzyme called cyclooxygenase that is critical in creating other chemicals that cause inflammation. [aaaai.org]

  Acetaminophen is the medicine most often used for fever and pain relief for people who cannot take aspirin and NSAIDs. Developed by RelayHealth. Published by RelayHealth. Copyright ©2014 McKesson Corporation and/or one of its subsidiaries. [summitmedicalgroup.com]

• Weakness

  The patient and control groups when combined showed weak, but significant correlation between platelet Se concentration and platelet GPX activity (r = 0.44; P = 0.03). [ncbi.nlm.nih.gov]

  Although paracetamol (acetaminophen) is a generally safe substitute for pain relief, it does have weak cyclooxygenase inhibitory properties. [healthengine.com.au]

  Nkiruka Erekosima, Tylenol® (acetaminophen) “is considered a weak COX-1 inhibitor, so some individuals with AERD may have a similar reaction to Tylenol® – at high doses – as they would to Aspirin”. [alphaallergy.com]

• Pathologist

  Images were acquired with HC Image software (Version 2.0.4) and evaluated by a pathologist who was blinded as to the subject's diagnosis. Cells staining for CD45 (green) and for both CD45 and CD61 (red) were counted. [doi.org]

• Rhinitis

  Keywords: Aspirin-Induced Asthma, Rhinitis, Bronchial asthma, aspirin induced asthma aia, ltc4 synthase, cox-2 inhibitors, cyclooxygenase, leukotriene, prostaglandins, lipoxins Title: Diagnosis, Prevention and Treatment of Aspirin-Induced Asthma and Rhinitis [doi.org]

  Bronchial sensitivity to methacholine in current and former asthmatics and allergic rhinitis patients and control subjects. [degruyter.com]

  Atopy, present in approximately a third of patients, led to earlier manifestation of rhinitis and asthma, but not of aspirin intolerance or nasal polyposis. [ncbi.nlm.nih.gov]

• Cough

  If you are prescribed an ACE inhibitor and develop a cough, speak with your doctor. [webmd.com]

  Patients initially present with an acute episode of vague malaise, sneezing, nasal obstruction, rhinorrhoea and often a productive cough. Persistent rhinitis and nasal polyps may then develop. [medsafe.govt.nz]

  […] variant asthma A form of asthma in which the predominant symptom is chronic, dry cough Other characteristic symptoms of asthma (e.g., wheezes, congestion, dyspnea ) are absent. [amboss.com]

  Respiratory symptoms (wheezing, dyspnea, cough) and chest pain that that radiates to the jaw or arms and is accompanied by diaphoresis and nausea develop together with nasal obstruction or rhinorrhea, periorbital edema, facial flushing or macular rash [symptoma.com]

• Sneezing

  There also often rhinitis symptoms (nasal congestion, runny nose and sneezing) and facial flushing. The asthma attack triggered by aspirin may be very severe and life threatening. [cityallergy.com]

  Patients initially present with an acute episode of vague malaise, sneezing, nasal obstruction, rhinorrhoea and often a productive cough. Persistent rhinitis and nasal polyps may then develop. [medsafe.govt.nz]

  The first symptoms of AIA may include sneezing, a runny or stuffy nose, and facial flushing. Symptoms happen within 1 to 3 hours after taking aspirin or NSAIDs. The asthma attack triggered by aspirin and NSAIDs can be life threatening. [kpjampang.com]

  The first symptoms of AIA may include sneezing, a runny or stuffy nose, and redness and warmth of the face. Symptoms start 1 to 3 hours after taking aspirin or NSAIDs. The asthma attack triggered by aspirin and NSAIDs can be life threatening. [summitmedicalgroup.com]

• Sputum

  Tacrolimus significantly inhibited bronchoconstriction and abrogated aspirin-induced increase in both sputum eosinophilic cationic protein and urinary leukotriene E(4) levels. [ncbi.nlm.nih.gov]

  It has also previously been shown that that activated sputum eosinophils from subjects with AIA produce increased levels of CysLTs ex vivo [ 4 ]. [doi.org]

  Eur Rev Med Pharmacol Sci 8:135–138 PubMed CAS Google Scholar Green RH, Brightling CE, Woltmann G et al (2002) Analysis of induced sputum in adults with asthma: identification of subgroup with isolated sputum neutrophilia and poor response to inhaled [link.springer.com]

  A comparative study of eicosanoid concentrations in sputum and urine in patients with aspirin-intolerant asthma. [hoajonline.com]

• Dyspnea

  […] characteristic symptoms of asthma (e.g., wheezes, congestion, dyspnea ) are absent. [amboss.com]

  The bronchial response (BR) was evidenced by dyspnea and spirometry, whereas the nasal response (NR) was evidenced by nasal symptoms and acoustic rhinometry and/or rhinomanometry. [ncbi.nlm.nih.gov]

  It is characterized by spasmodic contraction of airway smooth muscle, WHEEZING, and dyspnea ( DYSPNEA, PAROXYSMAL ). [hon.ch]

  Respiratory symptoms (wheezing, dyspnea, cough) and chest pain that that radiates to the jaw or arms and is accompanied by diaphoresis and nausea develop together with nasal obstruction or rhinorrhea, periorbital edema, facial flushing or macular rash [symptoma.com]

  Chiu 18 18 Congenital MVP,ASA.No regurgitation. dyspnea, dizziness worse with TDF/FTC/RAL Dr blames Dr. John Chiu Dr. Chiu Confusing: You need to use less abbreviations and provide a clearer description. [healthtap.com]

• Vomiting

  In addition to the typical respiratory reactions, about 10% of patients with AERD manifest skin symptoms like urticaria and/or gastrointestinal symptoms such as abdominal pain or vomiting during their reactions to aspirin. [2] In addition to aspirin, [ipfs.io]

  In addition to the typical respiratory reactions, about 10% of patients with AERD manifest skin symptoms such as urticaria and/or gastrointestinal symptoms such as abdominal pain or vomiting during their reactions to aspirin.[2] In addition to aspirin [en.wikipedia.org]

• Nausea

  Respiratory symptoms (wheezing, dyspnea, cough) and chest pain that that radiates to the jaw or arms and is accompanied by diaphoresis and nausea develop together with nasal obstruction or rhinorrhea, periorbital edema, facial flushing or macular rash [symptoma.com]

  She denied any lip, tongue and throat swelling, hives, red flushed skin, change in voice, nausea, diarrhea or CVS symptoms. She ate her lunch at noon and this happened at 5 PM. She denied any insect sting. [aaaai.org]

• Heart Failure

  The effect of spironolactone on morbidity and mortality in patients with severe heart failure. ‎ [books.google.de]

  Rising of the PCO 2 is a sign of respiratory fatigue and impending respiratory failure! [amboss.com]

• Tachycardia

  References: [3] [4] [6] [8] Complications Status asthmaticus Definition : extreme asthma exacerbation that does not respond to initial treatment with bronchodilators Clinical features Initially: orthopnea, tachypnea, tachycardia, hypoxemia and cyanosis [amboss.com]

  Features of acute severe asthma Inability to complete a sentence in one breath RR>25 Tachycardia >110 bpm PEF Features of life-threatening attack Silent chest Feeble respiratory effort Cyanosis Exhaustion Bradycardia Hypotenson Exhaustion/ confusion / [almostadoctor.co.uk]

• Chest Pain

  Respiratory symptoms (wheezing, dyspnea, cough) and chest pain that that radiates to the jaw or arms and is accompanied by diaphoresis and nausea develop together with nasal obstruction or rhinorrhea, periorbital edema, facial flushing or macular rash [symptoma.com]

• Flushing

  The typical reaction may be accompanied by intense rhinorhea, periorbital edema with conjunctival irritation and facial flushing. Often, at physical examination, nasal polyposis and serum eosinophilia are notable. [content.sciendo.com]

  Respiratory symptoms (wheezing, dyspnea, cough) and chest pain that that radiates to the jaw or arms and is accompanied by diaphoresis and nausea develop together with nasal obstruction or rhinorrhea, periorbital edema, facial flushing or macular rash [symptoma.com]

  A single dose of aspirin or, less commonly, other NSAIDs can provoke an acute asthmatic attack with rhinorrhoea, conjunctival irritation, and flushing of the head and neck due to post-exposure increase of eosinophil and secretion of cysteinyl leukotrienes [medical-dictionary.thefreedictionary.com]

  The first symptoms of AIA may include sneezing, a runny or stuffy nose, and facial flushing. Symptoms happen within 1 to 3 hours after taking aspirin or NSAIDs. The asthma attack triggered by aspirin and NSAIDs can be life threatening. [kpjampang.com]

  There also often rhinitis symptoms (nasal congestion, runny nose and sneezing) and facial flushing. The asthma attack triggered by aspirin may be very severe and life threatening. [cityallergy.com]

• Eruptions

  Within 20 minutes to three hours, patients experience nasal congestion in the upper airway, inflammation in the lower airway, runny eyes, and skin eruptions. [newswise.com]

  Karabulut, First multifocal bullous fixed drug eruption due to etodolac, Allergologia et Immunopathologia, 42, 3, (261), (2014). [doi.org]

• Eczema

  It is often accompanied by eczema. Non-atopic individuals can develop asthma in later life via sensitisation to e.g. occupational agents, aspirin, or as a result of taking β-blockers for hypertension or angina. [almostadoctor.co.uk]

• Headache

  Powders Bayer Children's Cold Tablet Stanback Headache Powders BC Powder St. [asthma.partners.org]

  Beta-blockers are commonly prescribed medications used to treat numerous conditions including heart conditions, high blood pressure, migraine headache, and, in eye drop form, glaucoma. [webmd.com]

  Most people don't think twice about popping an aspirin when they have a headache. But for some people with asthma, this simple remedy can be fatal. [verywellhealth.com]

The diagnosis of aspirin induced asthma is made from the history and clinical examination. In uncertain cases, challenge tests may be useful [8] for confirmation of the diagnosis. But, as they can provoke severe asthmatic episodes, they should only be performed in the hospital and aspirin can be administered by various routes: oral, nasal, bronchial and intravenous, in increasing doses for four consecutive days. Following administration, if a fall in forced expiratory volume in one second of at least 20% is observed, the test is considered positive [9]. Patients should receive leukotriene-modifying agents before the test because they have been proven to diminish the severity of bronchial constriction, while nasal and ocular symptoms tend to still appear, so the clinician can interpret the results of the test as positive. If lysine- aspirin is administered by inhalation route, only bronchial symptoms will occur. Inhalation tests may remain negative even in patients with positive oral tests. Oral and bronchial tests have similar specificity, but the oral test is more sensitive.

Several tests have been used over the years: histamine, methacholine, allergens and lysine-aspirin [10]. The Aspirin Sensitive Patient Identification Test is a new method to prove aspirin intolerance that still needs further validation [11].

Additional diagnostic methods include computer tomography scans of paranasal sinuses, that show mucosal hypertrophy and polyps. If the sinuses appear normal, the likelihood of aspirin-induced asthma is low.

Most patients are atopic [12] and some have increased respiratory antigen immunoglobulin E levels [13]. The peripheral eosinophil count can be high [14] and eosinophils are frequently found in the nasal and bronchial mucosa. The skin prick tests may be also positive for aeroallergens [15].

Weekly mean values of symptom scores were generally lower and PNIF measurements higher during treatment with FP than with placebo. This difference was statistically significant for most recorded parameters for the whole 4-week FP treatment. [ncbi.nlm.nih.gov]

Some other promising treatments, such as tacrolimus, have proven ineffective[92]. [aacijournal.biomedcentral.com]

Aspirin desensitization in the treatment of chronic rhinosinusitis. Curr Allergy Asthma Reports 2006, 6: 183–184. CrossRef Google Scholar 38. [doi.org]

Treatment and prognosis Treatment is largely centered around avoiding aspirin, treating underlying asthma and if need be polypectomy (surgical or medical). Unfortunately recurrences are common 2. [radiopaedia.org]

Abstract The etiology of aspirin-sensitive asthma is unknown, but a plausible hypothesis is that the inhibitory effect of aspirin on the cyclooxygenase enzyme increases formation of bronchoconstrictor leukotrienes via "shunting" of unmetabolized arachidonic [ncbi.nlm.nih.gov]

The etiology of ASA induced asthma is complex and not fully understood, but most evidence points towards an abnormality of arachidonic acid (AA) metabolism. [eurekaselect.com]

Asthma is a phenotypically heterogeneous disorder with many etiologic factors and clinical characteristics. T-bet, a Th1-specific transcription factor of T-box family, has been found to control interferon-gamma (IFN-gamma) expression in T cells. [uniprot.org]

Kevin Li, Andrew Lee and Waleed Abuzeid, Aspirin Exacerbated Respiratory Disease: Epidemiology, Pathophysiology, and Management, Medical Sciences, 10.3390/medsci7030045, 7, 3, (45), (2019). [doi.org]

Acetaminophen and the risk of asthma: The epidemiologic and pathophysiologic evidence. Chest. 2005;127(2):604-12. [Abstract | Full text] Hedman J, Kaprio J, Poussa T, Nieminen MM. [healthengine.com.au]

[…] asthma : typically > 40 years References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

James Bartley, Nutrition and the Upper Respiratory Tract, Nasal Physiology and Pathophysiology of Nasal Disorders, 10.1007/978-3-642-37250-6_14, (183-190), (2013). [doi.org]

She was awarded PhD and DSc degrees in specialities of pulmonology and pathophysiology in 1992 and 2002. She is a member of the European Respiratory Society (ERS) and European Network on Aspirin-Induced Asthma (AIANE). [microsoft.com]

These two nonspecific triggers may also share pathophysiologic mechanisms, including mast cell and leukotriene-related pathways, and may be related to vascular response–mediated airway narrowing. [accessmedicine.mhmedical.com]

Avoiding ASA and nonsteroidal anti-inflammatory drugs does not prevent progression of the inflammatory disease. Corticosteroids continue to be the mainstay of therapy, and anti-LT drugs are also indicated for treatment of the underlying disease. [ncbi.nlm.nih.gov]

Can it be prevented? AIA can be prevented. Avoid products that contain aspirin. Be sure to read labels. There are several medicines that contain aspirin or other NSAIDs. [kpjampang.com]

1. Fahrenholz JM. Natural history and clinical features of aspirin-exacerbated respiratory disease. Clin Rev Allergy Immunol. 2003; 24:113.
2. Szczeklik A, Nizankowska E, Duplaga M. Natural history of aspirin-induced asthma. AIANE Investigators. European Network on Aspirin-Induced Asthma. Eur Respir J. 2000; 16:432.
3. Sturtevant J. NSAID-induced bronchospasm: a common and serious problem; a report from MEDSAFE, the New Zealand medicines and medical devices safety authority. NZ Dent J. 1999; 95:84
4. Ta V, White AA. Survey-Defined Patient Experiences With Aspirin-Exacerbated Respiratory Disease. J Allergy Clin Immunol Pract. 2015; 3:711.
5. Marquette CH, Saulnier F, Leroy O, et al. Long-term prognosis of near-fatal asthma: a 6-year follow-up study of 145 asthmatic patients who underwent mechanical ventilation for a near-fatal attack of asthma. Am Rev Respir Dis. 1992; 146:76-81.
6. Shah NH, Schneider TR, DeFaria Yeh D, et al. Eosinophilia-Associated Coronary Artery Vasospasm in Patients with Aspirin-Exacerbated Respiratory Disease. J Allergy Clin Immunol Pract. 2016; 4:1215.
7. Cahill KN, Bensko JC, Boyce JA, Laidlaw TM. Prostaglandin D₂: a dominant mediator of aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2015; 135:245.
8. Szczeklik A, Stevenson DD. Aspirin-induced asthma: advances in pathogenesis and management. J Allergy Clin Immunol 1999;104:5–13.
9. Dahlen B, Zetterström O. Comparison of bronchial and peroral provocation with aspirin in aspirin-sensitive asthmatics. Eur Respir J. 1990; 3:527–534,
10. Pawlowicz A, Williams W, Davies B. Inhalation and nasal challenge in the diagnosis of aspirin-induced asthma. Allergy. 1991; 46:405–409
11. Jedrzejczak-Czechowicz M, Lewandowska-Polak A, Bienkiewicz B, Kowalski ML. Involvement of 15-lipoxygenase and prostaglandin EP receptors in aspirin-triggered 15-hydroxyeicosatetraenoic acid generation in aspirin-sensitive asthmatics. Clin Exp Allergy. 2008;38(7):1108-16
12. Dursun AB, Woessner KA, Simon RA, et al. Predicting outcomes of oral aspirin challenges in patients with asthma, nasal polyps, and chronic sinusitis. Ann Allergy Asthma Immunol. 2008;100:420.
13. Barranco P, Bobolea I, Larco JI, et al. Diagnosis of aspirin-induced asthma combining the bronchial and the oral challenge tests: a pilot study. J Investig Allergol Clin Immunol 2009;19:446.
14. Fountain CR, Mudd PA, Ramakrishnan VR, et al. Characterization and treatment of patients with chronic rhinosinusitis and nasal polyps. Ann Allergy Asthma Immunol. 2013; 111:337.
15. Kalyoncu AF, Karakaya G, Sahin AA, et al. Occurrence of allergic conditions in asthmatics with analgesic intolerance. Allergy. 1999;54:428–435.