Pattern of symptoms in the development of respiratory illness exacerbated by NSAIDs

October 19, 2023

3 min read

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Key points:

  • Patients presenting with asthma for the first time are younger.
  • First of all, patients who are sensitive to NSAIDs are mostly men.
  • The average age of first polyp onset is 35 years.

Age, sex, race, body mass index, and environmental exposure are associated with different patterns of development of respiratory disease exacerbated by NSAIDs, a study suggests. Journal of Allergy and Clinical Immunology: Practice.

These patterns can help clinicians better detect diseases and guide treatment, Kelly Nicole Daggs, MD, a guy is there write the Division of Allergic Diseases, Mayo Clinic Medicine, Rochester, Minn., and colleagues.

Researchers prospectively interviewed 240 adults (68% female; 77% nonwhite) with NSAID allergy, nasal polyposis, and asthma, considered the triad of NSAID-exacerbated respiratory disease (NERD). .

demo group

NERD presented in the order of asthma in 50% of patients, rhinitis/nasal polyps in 29%, NSAID allergy in 16%, and all symptoms simultaneously in 5%.

Researchers confirmed NSAID allergy by performing graded aspirin challenges in the clinic in 224 patients (93.3%). The diagnosis of the other 16 patients was derived from their medical history.

Sixty-four patients (27%) were unaware of NSAID allergy at initial presentation, with a median delay in diagnosis of 3 years (interquartile range (IQR), 0-5 years). In addition, 48 of these patients were not taking NSAIDs regularly and thus their allergy was the last symptom in a diagnosed triad, with a median delay in progression to asthma or polyps of 3 years (IQR, 0-5 years) .

Among 186 patients with a history of environmental allergy, 108 (58%) had documented sensitization to indoor allergens and 113 (61%) had documented sensitization to outdoor allergens. In addition, 129 of 220 patients (59%) with a history of exposure to environmental pollutants reported excessive exposure.

Seventy-two percent of patients who reported asthma as the earliest symptom in the triad were women, and the average age at first symptom onset was 25 years, significantly younger than with other manifestations.ask < .001). Eleven patients developed asthma with a mean age of onset of 35 years, nasal polyps, and NSAID sensitivity with a mean age of 37 years.

70% of patients who first reported rhinitis/sinusitis or nasal polyps were women, with a mean age of onset of 35 years, mean age of asthma onset of 38 years, and NSAID sensitivity of 42 years.

Fifty-one percent of patients who reported NSAID sensitivity before developing other symptoms were male, and the average age at onset was 35 years. These patients were more likely to report exposure to environmental pollution (81%; ask = .002) and had higher baseline IgE levels (290 IU/mL; IQR, 146-525; ask = .009) higher than the other groups. Once NSAID hypersensitivity occurs in these patients, the average age at onset of asthma is 39 years and the average age of onset of nasal polyps is 40 years.

83% of patients with all three symptoms of the triad were female, the average age at onset was 33 years, and baseline IgE levels (98 IU/mL; IQR, 43-154) were lower than those in the other groups (ask =.009).

The connection between exposure and presentation

Researchers say differences in the percentage of patients with a history of overexposure to pollution (ask = .002) and intrusion (ask = .02) significant between groups. By race and ethnicity, 76% of Latino patients, 63% of black patients, 52% of patients of other races, and 44% of white patients reported pollution exposure (ask =.006).

Although 78% of patients had an overall history of indoor and/or outdoor allergies, the researchers found no significant association between the order of triad symptoms and the presence of these allergies.

Compared with other sequences, the asthma priority sequence was significantly associated with BMI, with an odds ratio of 1.3 (95% CI, 1.06-1.7) per 5 BMI units.

Additionally, younger age at asthma onset was associated with female gender (OR = 5.3; 95% CI, 1.4-20), Latino race (OR = 6.7; 95% CI, 1.3-34), and higher BMI (OR per 5 BMI units) correlation = 1.5; 95% CI, 1.01-2.3).

Polyp precedence was associated with older age at onset of NSAID allergy (OR = 1.03; 95% CI, 1.01-1.06).

NSAID hypersensitivity priority sequence was significantly associated with male sex (OR = 3.3; 95% CI, 1.5-7.4) and pollution exposure (OR = 4.4; 95% CI, 1.6-11.9).

Although NERD typically begins in the third and fourth decades of life and affects women more, the onset of symptoms varies and the disease may follow a complex modeled pathway from development to diagnosis, the researchers said.

Understanding these underlying risk factors and progression is key to physicians’ ability to promptly identify and treat disease, and the ability to predict disease course based on these factors is now a tangible goal, the researchers continue.

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