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ASS-Toleranzinduktion

Therapieoption bei Patienten mit analgetikainduzierter Erkrankung der Atemwege

Aspirin desensitization

Therapy options in patients with aspirin-exacerbated respiratory disease

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Zusammenfassung

Die spezifische orale Toleranzinduktion (SOTI) mit Acetylsalicylsäure (ASS) hat sich in der Therapie der analgetikainduzierten Erkrankung der Atemwege als zusätzliche Therapieoption bei rezidivierender chronischer Rhinosinusitis mit Nasenpolypen bewährt. Aufgrund des Risikos schwerwiegender Nebenwirkungen wird dringend eine stationäre Durchführung empfohlen. Die Beachtung notwendiger struktureller Voraussetzungen, formaler Bedingungen sowie der Indikation und Kontraindikationen ist auch medikolegal wichtig. Als Dauertherapie werden derzeit 300 (– 500) mg ASS empfohlen. Die Indikation besteht bei persistierenden Symptomen trotz intensiver medikamentöser Therapie und/oder rezidivierender Polyposis nasi, die wiederholt Operationen notwendig macht und/oder bei Patienten, die häufiger Kortison einnehmen müssen, um nasale Symptome oder das Asthma zu kontrollieren. Wenn die ASS-Einnahme von mehr als 48 h unterbrochen wurde, wird die erneute SOTI empfohlen, da mit einem erneuten Auftreten von Intoleranzreaktionen zu rechnen ist.

Abstract

Aspirin desensitization has established itself as an additional therapy option in the treatment of aspirin- exacerbated respiratory disease, recurrent chronic rhinosinusitis and nasal polyps. Inpatient treatment is strongly recommended due to the risk of life-threatening side effects. In addition, the necessary requirements, indications and contraindications should be carefully considered from a medicolegal perspective. A maintenance dose of 300 ( −500) mg ASS is currently recommended. Indications include persisting symptoms despite intensive medical care and/or recurrent nasal polyps, leading to recurrent sinus operations and/or the need to take systemic corticosteroids in order to control nasal symptoms or asthma. If ASS intake is interrupted for more than 48 h, aspirin desensitization should be resumed to prevent renewed intolerance reactions.

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Literatur

  1. Alonso-Llamazares A, Martinez-Cócera C, Domínguez-Ortega J et al (2002) Nasal provocation test (NPT) with aspirin: a sensitive and safe method to diagnose aspirin-induced asthma (AIA). Allergy 57:632–635

    Article  PubMed  CAS  Google Scholar 

  2. Antithrombotic Trialists Collaboration (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomized trials. Lancet 373:1849–1860

    Article  Google Scholar 

  3. Berger JS, Lala A, Krantz MJ et al (2011) Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: a meta-analysis of randomized trials. Am Heart J 162:115–124

    Article  PubMed  CAS  Google Scholar 

  4. Berges-Gimeno M, Simon RA, Stevenson DD (2003) Treatment with aspirin desensitization in patients with aspirin exacerbated respiratory disease. J Allergy Clin Immunol 111:180–186

    Article  PubMed  CAS  Google Scholar 

  5. Berges-Gimeno MP, Simon RA, Stevenson DD (2003) Early effects of aspirin desensitization treatment in asthmatic patients with aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 90:33841

    Article  Google Scholar 

  6. Berges-Gimeno MP, Simon RA, Stevenson DD (2002) The effect of leukotriene-modifier drugs on aspirin-induced asthma and rhinitis reactions. Clin Exp Allergy 32:1491–1496

    Article  PubMed  CAS  Google Scholar 

  7. Berges-Gimeno MP, Simon RA, Stevenson DD (2002) The natural history and clinical characteristics of aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 89:474–478

    Article  PubMed  Google Scholar 

  8. Bhatt DL, Scheiman J, Abraham NS et al (2008) American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 52:1502–1517

    Article  PubMed  Google Scholar 

  9. Dahlén SE, Malmström K, Nizankowska E et al (2002) Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist: a randomized, double-blind, placebo-controlled trial. Am J Respir Crit Care Med 165:9–14

    PubMed  Google Scholar 

  10. Dahlén SE (2006) Treatment of asthma with antileukotrienes: first line or last resort therapy? Eur J Pharmacol 533:40–56

    Article  PubMed  Google Scholar 

  11. DeMarcantonio MA, Han JK (2010) Systemic therapies in managing sinonasal inflammation. Otolaryngol Clin North Am 43:551–563

    Article  PubMed  Google Scholar 

  12. Derry S, Loke YK (2000) Risk of gastrointestinal haemorrhage with long-term use of aspirin: a meta-analysis. BMJ 321:1183–1187

    Article  PubMed  CAS  Google Scholar 

  13. Dollner R, Klimek L, Pfaar O et al (2007) In-vitro-Testverfahren bei Analgetikaintoleranz. Allergologie 30:240–248

    Google Scholar 

  14. Fahrenholz JM (2003) Natural history and clinical features of aspirin-exacerbated respiratory disease. Clin Rev Allergy Immunol 24:113–124

    Article  PubMed  CAS  Google Scholar 

  15. Fischbach W, Malfertheiner P, Hoffmann JC et al (2009) Helicobacter pylori and gastroduodenale Ulkuskrankheit. Dtsch Arztebl Int 106:801–808

    PubMed  Google Scholar 

  16. Fokkens W (2007) European position paper on rhinosinusitis and nasal polyps. Rhinol Suppl 20:1–136

    PubMed  Google Scholar 

  17. Förster U, Olze H (2008) Analgetika-Intoleranz. HNO 56:443–451

    Article  PubMed  Google Scholar 

  18. Gosepath J, Schäfer D, Amedee RG, Mann WJ (2001) Individual monitoring of aspirin desensitization. Arch Otolaryngol Head Neck Surg 127:316–321

    PubMed  CAS  Google Scholar 

  19. Gosepath J, Schäfer D, Mann WJ (2002) Analgetika-Intoleranz: Langzeitergebnisse bis zu 3 Jahren bei adaptiver Desaktivierung mit einer täglichen Erhaltungsdosis von 100 mg Aspirin. Laryngorhinootologie 81:732–738

    Article  PubMed  CAS  Google Scholar 

  20. Hernández-Díaz S, Rodríguez LA (2000) Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med 160:2093–2099

    Article  PubMed  Google Scholar 

  21. Hope AP, Woessner KA, Simon RA, Stevenson DD (2009) Rational approach to aspirin dosing durgin oral challenges and desensitization of patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 123:406–410

    Article  PubMed  CAS  Google Scholar 

  22. Hosemann W, Kühnel T, Pfeifer M (2000) Analgetikaintoleranz und Polyposis nasi. Laryngorhinootologie 79:53–65

    Article  PubMed  CAS  Google Scholar 

  23. Hosemann W, Schwab N, Praetner L et al (2003) Erweiterte Ergebnisanalyse nach endonasaler Nasennebenhöhlenchirurgie. Laryngorhinootologie 82:341–346

    Article  PubMed  CAS  Google Scholar 

  24. Hosemann W (2003) Postoperative Rezidivprophylaxe bei chronischer Pansinusitis und Polyposis nasi. HNO 51:279–283

    Article  PubMed  CAS  Google Scholar 

  25. Hosemann W (2000) Surgical treatment of nasal polyposis in patients with aspirin intolerance. Thorax 55(Suppl 2): S87–S90

    Article  PubMed  Google Scholar 

  26. Jenkins C, Costello J, Hodge L (2004) Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 328:434

    Article  PubMed  CAS  Google Scholar 

  27. Jenneck C, Jürgens U, Buecheler M, Novak N (2007) Pathogenesis, diagnosis and treatment of aspirin intolerance. Ann Allergy Asthma Immunol 99:13–21

    Article  PubMed  CAS  Google Scholar 

  28. Jung H (2009) Die chronische Rhinosinusitis bei Morbus Widal: Krankheitsbild und Therapiemöglichkeiten. Praxis 98:1361–1365

    Article  PubMed  CAS  Google Scholar 

  29. Kamani T, Sama A (2011) Management of nasal polyps in ‚aspirin sensitive asthma‘ triad. Curr Opin Otolaryngol Head Neck Surg 19:6–10

    Article  PubMed  Google Scholar 

  30. Kelly JP, Kaufman DW, Jurgelon JM et al (1996) Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet 348:1413–1416

    Article  PubMed  CAS  Google Scholar 

  31. Klimek L, Pfaar O (2009) Aspirin intolerance: does desensitization alter the course of the disease? Immunol Allergy Clin North Am 29:669–675

    Article  PubMed  CAS  Google Scholar 

  32. Kowalski ML, Makowska JS, Blanca M et al (2001) Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) – classification, diagnosis and management: review of the EAACI/ENDA(#) and GA2LEN/HANNA*. Allergy 66:818–829

    Article  Google Scholar 

  33. Kurata JJ, Abbey DE (1990) The effect of chronic aspirin use on duodenal and gastric ulcer hospitalisations. J Clin Gastroenterol 12:260–266

    Article  PubMed  CAS  Google Scholar 

  34. Laine L (2001) Approaches to nonsteroidal anti-inflammatory drug use in the high-risk patient. Gastroenterology 120:594–606

    Article  PubMed  CAS  Google Scholar 

  35. Lama PJ (2002) Systemic adverse effects of beta-adrenergic blockers: an evidence-based assessment. Am J Ophthalmol 134:749–760

    Article  PubMed  CAS  Google Scholar 

  36. Lanas A, Wu P, Medin J, Mills EJ (2011) Low doses of acetylsalicylic Acid increase risk of gastrointestinal bleeding in a meta-analysis. Clin Gastroenterol Hepatol 9:762–768

    Article  PubMed  CAS  Google Scholar 

  37. Lee JY, Simon RA, Stevenson DD (2007) Selection of aspirin dosages for aspirin desensitization treatment in patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 119:157–164

    Article  PubMed  CAS  Google Scholar 

  38. Lee RU, Stevenson DD (2011) Aspirin-exacerbated respiratory disease: evaluation and management. Allergy Asthma Immunol Res 3:3–10

    Article  PubMed  CAS  Google Scholar 

  39. Lee RU, White AA, Ding D et al (2010) Use of intranasal ketorolac and modified oral aspirin challenge for desensitization of aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 105:130–135

    Article  PubMed  CAS  Google Scholar 

  40. Macy E, Bernstein JA, Castells MC et al (2007) Aspirin challenge and desensitization. A practice paper. Ann Allergy Asthma Immunol 98:172–174

    Article  PubMed  CAS  Google Scholar 

  41. Mardiney M, Borish L (2001) Aspirin desensitization for chronic hyperplastic sinusitis, nasal polyposis, and asthma triad. Arch Otolaryngol Head Neck Surg 127:1287

    PubMed  CAS  Google Scholar 

  42. Mayr S, Schick B (2009) Role of etiology in revision endoscopic sinus surgery. In: Stucker FJ, Suza CD, Canyon GS, Lian TS, Draf W, Schick B (Hrgs) Rhinology and facial plastic surgery. Springer, New York, S 606–616

  43. McMains KC, Kountakis SE (2006) Medical and surgical considerations in patients with Samter’s triad. Am J Rhinol 20:573–576

    Article  PubMed  Google Scholar 

  44. Micheletto C, Tognella S, Visconti M et al (2004) Montelukast 10 mg improves nasal function and nasal response to aspirin in ASA-sensitive asthmatics: a controlled study vs placebo. Allergy 59:289–294

    Article  PubMed  CAS  Google Scholar 

  45. Nieminen T, Lehtimäki T, Mäenpää J et al (2007) Ophthalmic timolol: plasma concentration and systemic cardiopulmonary effects. Scand J Clin Lab Invest 67:237–245

    Article  PubMed  CAS  Google Scholar 

  46. Nizankowska-Mogilnicka E et al (2007) EAACI/GA2LEN Guideline: Aspirin provocation tests for diagnosis of aspirin hypersensitivity. Allergy 62:1111–1118

    Article  PubMed  CAS  Google Scholar 

  47. Palikhe NS, Kim JH, Park HS (2009) Update of recent advances in the management of aspirin exacerbated respiratory disease. Yonsei Med J 50:744–750

    Article  PubMed  CAS  Google Scholar 

  48. Pfaar O, Klimek L (2006) Eicosanoids, aspirin-intolerance and the upper airways–current standards and recent improvements of the desensitization therapy. J Physiol Pharmacol 57(Suppl 12):5–13

    PubMed  Google Scholar 

  49. Pfaar O, Spielhaupter M, Wrede H et al (2006) Adaptive Desaktivierung bei ASS-intoleranten Patienten mit Polyposis nasi et sinuum. Allergologie 29:322–331

    Google Scholar 

  50. Rahme E, Nedjar H, Bizzi A, Morin S (2007) Hospitalization for gastrointestinal adverse events attributable to the use of low-dose aspirin among patients 50 years or older also using non-steroidal anti-inflammatory drugs: a retrospective cohort study. Aliment Pharmacol Ther 26:1387–1398

    Article  PubMed  CAS  Google Scholar 

  51. Randerath WJ, Galetke W (2007) Differenzialdiagnose der rezidivierenden Polyposis nasi: das Analgetika-Asthma-Syndrom. Dtsch Arztebl 104:A3178–A3183

    Google Scholar 

  52. Rasp G (2010) Is there a role for leukotriene antagonists in the prevention of recurrent nasal polyps? Curr Opin Allergy Clin Immunol 10:200–205

    Article  PubMed  CAS  Google Scholar 

  53. Riechelmann H, Bachert C, Goldschmidt O et al (2002) Durchführung des nasalen Provokationstests bei Erkrankungen der oberen Atemwege. Allergo J 11:29–36

    Google Scholar 

  54. Rizk H (2011) Role of aspirin desensitization in the management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 19:210–217

    Article  PubMed  Google Scholar 

  55. Rosado A, Vives R, González R, Rodríguez J (2003) Can NSAIDs intolerance disappear? A study of three cases. Allergy 58:689–690

    Article  PubMed  CAS  Google Scholar 

  56. Rostom A, Dube C, Wells G et al (2002) Prevention of NSAID-induced gastroduodenal ulcers. Cochrane Database Syst Rev CD002296

  57. Rozsasi A, Polzehl D, Deutschle T et al (2008) Long-term treatment with aspirin desensitization: a prospective clinical trial comparing 100 and 300 mg aspirin daily. Allergy 63:1228–1234

    Article  PubMed  CAS  Google Scholar 

  58. Schapowal AG, Simon HU, Schmitz-Schumann M et al (1995) Phenomenology, pathogenesis, diagnosis and treatment of aspirin-sensitive rhinosinusitis. Acta Otorhinolaryngol Belg 49:235–250

    PubMed  CAS  Google Scholar 

  59. Schuman JS (2000) Antiglaucoma medications: a review of safety and tolerability issues related to their use. Clin Ther 22:167–120

    Article  PubMed  CAS  Google Scholar 

  60. Shaker M, Lobb A, Jenkins P et al (2008) An economic analysis of aspirin desensitization in aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 121:81–87

    Article  PubMed  CAS  Google Scholar 

  61. Slattery J, Warlow CP, Shorrock CJ, Langman MJ (1995) Risks of gastrointestinal bleeding during secondary prevention of vascular events with aspirin-analysis of gastrointestinal bleeding during the UK-TIA trial. Gut 37:509–511

    Article  PubMed  CAS  Google Scholar 

  62. Stevenson DD, Hankammer MA, Mathison DA et al (1996) Aspirin desensitization treatment of aspirin-sensitive patients with rhinosinusitis-asthma: long-term outcomes. J Allergy Clin Immunol 98:751–758

    Article  PubMed  CAS  Google Scholar 

  63. Stevenson DD, Simon RA (2006) Selection of patients for aspirin desensitization treatment. J Allergy Clin Immunol 118:801–804

    Article  PubMed  Google Scholar 

  64. Stevenson DD (2009) Aspirin sensitivity and desensitization for asthma and sinusitis. Curr Allergy Asthma Rep 9:155–163

    Article  PubMed  CAS  Google Scholar 

  65. Szczeklik A, Nizankowska E, Duplaga M (2000) Natural history of aspirin-induced asthma. Eur Respir J 16:432–436

    Article  PubMed  CAS  Google Scholar 

  66. Szczeklik A, Nizankowska E, Sanak M, Swierczynska M (2001) Aspirin-induced rhinitis and asthma. Curr Opin Allergy Clin Immunol 1:27–33

    PubMed  CAS  Google Scholar 

  67. Szczeklik A, Stevenson DD (2003) Aspirin-induced asthma: advances on pathogenesis, diagnosis and management. J Allergy Clin Immunol 111:913–9121

    Article  PubMed  CAS  Google Scholar 

  68. Trautmann A (2006) Allergiediagnose-Allergietherapie. Thieme, Stuttgart

  69. Umbreit C, Virchow JC, Thorn C et al (2010) Aspirin-Intolerance-Syndrom: a common and interdisciplinary disease. Internist 51:1196–1201

    Article  PubMed  CAS  Google Scholar 

  70. Vally H, Taylor ML, Thompson PJ (2002) The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Thorax 57:569–574

    Article  PubMed  CAS  Google Scholar 

  71. Weber RK (2011) ASS-Desaktivierung. In: Heppt W, Bachert C (Hrsg) Allergologie, 2. Aufl. Thieme, Stuttgart, S 306–312

  72. Weber RK (2006) Persistierende chronische Sinusitis nach Nasennebenhöhlenoperation. Laryngorhinootologie 85:667–685

    Article  PubMed  CAS  Google Scholar 

  73. Weil J, Colin-Jones D, Langman M et al (1995) Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 310:827–830

    Article  PubMed  CAS  Google Scholar 

  74. Weil J, Langman MJ, Wainwright P et al (2000) Peptic ulcer bleeding: accessory risk factors and interactions with non-steroidal anti-inflammatory drugs. Gut 46:27–31

    Article  PubMed  CAS  Google Scholar 

  75. White A, Ludington E, Mehra P et al (2006) Effect of leukotriene modifier drugs on the safety of oral aspirin challenges. Ann Allergy Asthma Immunol 97:688–693

    Article  PubMed  CAS  Google Scholar 

  76. White AA, Hope AP, Stevenson DD (2006) Failure to maintain an aspirin-desensitized state in a patient with aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 97:446–448

    Article  PubMed  Google Scholar 

  77. White AA, Stevenson DD, Simon RA (2005) The blocking effect of essential controller medications during aspirin challenges in patients with aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 95:330–335

    Article  PubMed  CAS  Google Scholar 

  78. Williams AN, Simon RA, Woessner KM, Stevenson DD (2007) The relationship between historical aspirin-induced asthma and severity of asthma induced during oral aspirin challenges. J Allergy Clin Immunol 120:273–277

    Article  PubMed  CAS  Google Scholar 

  79. Williams AN, Woessner KM (2008) The clinical effectiveness of aspirin desensitization in chronic rhinosinusitis. Curr Allergy Asthma Rep 8:245–252

    Article  PubMed  CAS  Google Scholar 

  80. Zahnd R, Fricker M, Caversaccio M et al (2009) Ambulante, inhalative bronchiale Provokation mit L-Acetylsalicylsäure: Diagnostischer Test bei Verdacht auf Aspirin/NSAID-Intoleranz. Allergologie 32:128–135

    Google Scholar 

  81. Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2010) Nationale VersorgungsLeitlinie Asthma, 2. Aufl. AWMF-Register nvl/002. http://www.asthma.versorgungsleitlinien.de/. Zugegriffen: 07.11.11

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Authors and Affiliations

  1. Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie,HNO-Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland

    R. Weber & W. Heppt

  2. Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    A. Trautmann

  3. Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien gGmbH, Solingen, Deutschland

    W. Randerath

  4. Universitäts-HNO-Klinik, Ernst-Moritz-Arndt-Universität, Greifswald, Deutschland

    W. Hosemann

  5. Nasenzentrum Marburg, Universitäts-HNO-Klinik, UKGM, Marburg, Deutschland

    R. Weber

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Weber, R., Trautmann, A., Randerath, W. et al. ASS-Toleranzinduktion. HNO 60, 369–383 (2012). https://doi.org/10.1007/s00106-011-2444-3

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