Original Article

The Effect of Aspirin on Moderate to Severe Asthmatic Patients with Aspirin Hypersensitivity, Chronic Rhinosinusitis, and Nasal Polyposis

Low Dose Aspirin in Asthma and Aspirin Hypersensitivity


Asthmatic patients may have aspirin-exacerbated respiratory disease and experience acute dyspnea and nasal symptoms within 3 hours after the ingestion of aspirin. This study aimed to evaluate the effect and outcome of daily low-dose aspirin in the treatment of moderate to severe asthma in patients with concomitant aspirin hypersensitivity and chronic rhinosinusitis with nasal polyposis (CRSwNP).
This clinical trial was conducted from February 2014 to February 2015 on 46 adult patients with moderate to severe asthma accompanied by CRSwNP. Patients with a positive aspirin challenge were blindly randomized in three groups receiving placebo/day (A); aspirin 100 mg/day (B); and aspirin 325mg/day (C), respectively. Clinical findings, FEV1 and ACT scores were recorded and compared before, during, and after treatment for 6 months.
Of 46 participants at baseline, 30 patients completed this 6-month trial study. The level of asthma control was significant; based on Asthma Control Test (ACT) when comparing the results in groups A and C and also groups B and C, but it was not significant when comparing ACT scores between groups A and B. FEV1 before and after treatment was significant when comparing groups A and B, groups A and C, and groups B and C.
To conclude, aspirin desensitization with a daily dose of 325 mg aspirin resulted in the improvement of long-term control of asthma. A daily aspirin dose of 100 mg was not associated with such an increase in ACT score.

1. Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bousquet J, et al. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA and GA2LEN/HANNA. Allergy. 2011;66(7):818-29.
2. Berges-Gimeno MP, Simon RA, Stevenson DD. Long-term treatment with aspirin desensitization in asthmatic patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2003;111(1):180-6.
3. Sweet JM, Stevenson DD, Simon RA, Mathison DA. Long-term effects of aspirin desensitization—treatment for aspirin-sensitive rhinosinusitis-asthma. J Allergy Clin Immunol. 1990;85(1):59-65.
4. Hope AP, Woessner KA, Simon RA, Stevenson DD. Rational approach to aspirin dosing during oral challenges and desensitization of patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2009;123(2):406-10.
5. Peters AT, Spector S, Hsu J, Hamilos DL, Baroody FM, Chandra RK, et al. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol. 2014;113(4):347-85.
6. 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.
7. Reddel HK, Hurd SS, FitzGerald JM. World Asthma Day. GINA 2014: a global asthma strategy for a global problem. Intl J Tuberc Lung Dis. 2014;18(5):505-6.
8. Park HS, Kowalski ML, TM L. Hypersensitivity to Aspirin and Other Nonsteroidal Antiinflammatory Drugs. In: Burks AW, Holgate ST, O'Hehir RE, Broide DH, Bacharier LB, Khurana Hershey GK, et al., editors. Middleton's Allergy Principles and Practice. 2: Elsevier; 2019. p. 1298.
9. Comert S, Karakaya G, Kalyoncu AF. Aspirin desensitization treatment for the management of aspirin-exacerbated respiratory disease. J Respir Res. 2016;2(1):24-7.
10. Comert S, Celebioglu E, Yucel T, Erdogan T, Karakaya G, Onerci M, et al. Aspirin 300 mg/day is effective for treating aspirin-exacerbated respiratory disease. Allergy. 2013;68(11):1443-51.
11. Szczeklik A, Niz E. Clinical features and diagnosis of aspirin induced asthma. Thorax. 2000;55(suppl 2):S42-S4.
12. Kwok CS, Loke YK. Critical overview on the benefits and harms of aspirin. Pharmaceuticals. 2010;3(5):1491-506.
13. White AA, Stevenson DD, editors. Aspirin-exacerbated respiratory disease: update on pathogenesis and desensitization. Seminars in respiratory and critical care medicine; 2012: Thieme Medical Publishers.
14. 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. e1.
15. Rozsasi A, Polzehl D, Deutschle T, Smith E, Wiesmiller K, Riechelmann H, et al. Long-term treatment with aspirin desensitization: a prospective clinical trial comparing 100 and 300 mg aspirin daily. Allergy. 2008;63(9):1228-34.
16. Swierczynska-Krepa M, Sanak M, Bochenek G, Strek P, Cmiel A, Gielicz A, et al. Aspirin desensitization in patients with aspirin-induced and aspirin-tolerant asthma: a double-blind study. J Allergy Clin Immunol. 2014;134(4):883-90.
17. Esmaeilzadeh H, Nabavi M, Aryan Z, Arshi S, Bemanian MH, Fallahpour M, et al. Aspirin desensitization for patients with aspirin-exacerbated respiratory disease: a randomized double-blind placebo-controlled trial. J Clinl Immunol. 2015;160(2):349-57.
18. Levy JM, Smith TL. Is aspirin desensitization indicated for the treatment recalcitrant chronic rhinosinusitis with nasal polyposis in aspirin-exacerbated respiratory disease? Laryngoscope. 2017;127(4):776-7.
19. Li KL, Lee AY, Abuzeid WM. Aspirin Exacerbated Respiratory Disease: Epidemiology, Pathophysiology, and Management. Med Sci. 2019;7(3):45.
IssueVol 20 No 3 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijaai.v20i3.6330
Aspirin Asthma Nasal polyps

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, Darougar S, Nabavi M, Bemanian MH, Fallahpour M, Shokri S, Ahmadian J, Molatefi R, Rekabi M, Moinfar Z, Hashemitari P, Eslami N. The Effect of Aspirin on Moderate to Severe Asthmatic Patients with Aspirin Hypersensitivity, Chronic Rhinosinusitis, and Nasal Polyposis. Iran J Allergy Asthma Immunol. 20(3):287-293.