Brief Communication

Aspirin Sensitivity in Patients with Moderate to Severe Asthma


Asthma induced by ingestion of aspirin occurs when symptoms arise within 30 minutes to three hours after aspirin consumption. Previous data indicate that sensitivity to aspirin may be associated with poorly controlled asthma. This study aims to evaluate the frequency of aspirin sensitivity in patients with moderate to severe asthma receiving conventional asthma therapy.
This clinical trial was conducted on 65 patients aged 18 to 65 years with moderate to severe asthma from February 2015 to February 2016 at the Allergy Department, Hazrat-e-Rasoul Hospital, Iran University of Medical Sciences, Tehran. To assess treatment responses in patients, forced expiratory volume in the first second (FEV1) and asthma control test (ACT) scores were measured at baseline and after 3 months.
The results of the oral aspirin challenge revealed a prevalence of 35.38% for sensitivity to aspirin. Hypersensitivity reactions to aspirin were detected in 60.9% of the patients with moderate asthma and 39.1% of the patients with severe asthma. All patients with positive aspirin challenge tests suffered from rhinosinusitis and in 56.5% of cases, history of previous hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) was detected. No meaningful differences were found between those patients with aspirin sensitivity and those with aspirin tolerance neither in mean pre-bronchodilator FEV1 nor in ACT scores pre- and post-treatment.
To conclude, aspirin sensitivity was not found to have an association with an unfavorable response to conventional treatment in patients with uncontrolled asthma. 

1. Global Initiative for Asthma Management. GINA Report, Global Strategy for Asthma Management and Prevention 2011.
2. Machado-Carvalho L, Roca-Ferrer J, Picado C. Prostaglandin E2 receptors in asthma and in chronic rhinosinusitis/nasal polyps with and without aspirin hypersensitivity. Respir Res. 2014;15(1):100.
3. Sakalar EG, Muluk NB, Kar M, Cingi C. Aspirin-exacerbated respiratory disease and current treatment modalities. Eur Arch Otorhinolaryngol. 2016:DOI: 10.1007/s00405-016-4273-1
4. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. Bmj. 2004;328(7437):434.
5. Lee RU, Stevenson DD. Aspirin-exacerbated respiratory disease: evaluation and management. Allergy Asthma Immunol Res. 2011;3(1):3-10.
6. Makowska J, Lewandowska–Polak A, Kowalski ML. Hypersensitivity to aspirin and other NSAIDs: diagnostic approach in patients with chronic rhinosinusitis. Curr Allergy Asthma Rep. 2015;15(8):47.
7. Kennedy JL, Stoner AN, Borish L. Aspirin-exacerbated respiratory disease: Prevalence, diagnosis, treatment, and considerations for the future. Am J Rhinol Allergy. 2016;30(6):407-13.
8. Stevenson DD, Szczeklik A. Clinical and pathologic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol. 2006;118(4):773-86.
9. Li KL, Lee AY, Abuzeid WM. Aspirin Exacerbated Respiratory Disease: Epidemiology, Pathophysiology, and Management. Med Sci (Basel). 2019;7(3):45.
10. Dursun AB, Woessner KA, Simon RA, Karasoy D, Stevenson DD. Predicting outcomes of oral aspirin challengesin patients with asthma, nasal polyps, andchronic sinusitis. Ann Allergy Asthma Immunol. 2008;100(5):420-5.
11. Bochenek G, Niżankowska-Mogilnicka E. Aspirin-exacerbated respiratory disease: clinical disease and diagnosis. Immunol Allergy Clin North Am. 2013;33(2):147-61.
12. National AE, Prevention P. Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol. 2007;120(5 Suppl):S94.
13. Mascia K, Haselkorn T, Deniz YM, Miller DP, Bleecker ER, Borish L. Aspirin sensitivity and severity of asthma: evidence for irreversible airway obstruction in patients with severe or difficult-to-treat asthma. J Allergy Clin Immunol. 2005;116(5):970-5.
14. Moore W. National Heart, Lung, Blood Institute's Severe Asthma Research Program. Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program. J Allergy Clin Immunol. 2007;119:405-13.
15. Rajan JP, Wineinger NE, Stevenson DD, White AA. Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: A meta-analysis of the literature. J Allergy Clin Immunol. 2015;135(3):676-81.
16. Bochenek G, Kuschill-Dziurda J, Szafraniec K, Plutecka H, Szczeklik A, Nizankowska-Mogilnicka E. Certain subphenotypes of aspirin-exacerbated respiratory disease distinguished by latent class analysis. J Allergy Clin Immunol. 2014;133(1):98-103.
IssueVol 19 No 4 (2020) QRcode
SectionBrief Communication
Asthma Aspirin Hypersensitivity

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Arshi S, Eslami N, Nabavi M, Bemanian M, Fallahpour M, Shokri S, Ahmadian J, Molatefi R, Darabi K, Sedighi GR, Moinfar Z, Darougar S. Aspirin Sensitivity in Patients with Moderate to Severe Asthma. Iran J Allergy Asthma Immunol. 2020;19(4):447-451.