Aspirin intolerance and nasal polyps

Abstract

The full clinical picture of aspirin intolerance, the Sampter triad, is associated with nasal polyposis, clinical sensitivity to most nonsteroidal anti-inflammatory drugs, and intrinsic bronchial asthma. The triad can be incomplete, however, and nasal polyposis can be the first clinical symptom of aspirin sensitivity. The recurrence rate of nasal polyps after surgical therapy is high in these patients but can be reduced by a long-term desensitization therapy with oral aspirin. Although the exact mechanisms of aspirin intolerance as well as those of desensitization remain obscure, an in vitro assay on eicosanoid metabolism has been proven to be helpful in diagnosis and treatment as it correlates well to the individual severity of clinical symptoms. It can be used to unveil aspirin sensitivity in cases of an incomplete clinical triad and to monitor the effectiveness of desensitization over time. This paper reviews the role of the in vitro assay and presents a desensitization protocol that can be maintained as a long-term treatment without adverse side effects. The risk of recurrence if the treatment is discontinued is also discussed.