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Aspirin-induced asthma, also called aspirin-hypersensitive asthma, is a special type of bronchial asthma that is usually moderate to severe.
So far, the mechanism of the development of aspirin-induced asthma has not been fully understood. There are many hypotheses – from inhibiting the production of the cyclooxygenase enzyme (this is the enzyme responsible for the formation of chemical compounds that are local informants for cells), through chronic viral infection, to the destructive power of leukotrienes, i.e. lipids related to the immune system.
In our country, the problem of hypersensitivity to aspirin concerns 4,3% of people. asthmatics. It occurs more often in women than in men. 15 percent people are unaware that they cannot tolerate aspirin. Hypersensitivity to aspirin and other NSAIDs rarely affects children.
Two forms of intolerance
There are two clinical forms of aspirin-induced asthma.
The first is the bronchospastic form in which the symptoms of the upper and lower respiratory tract predominate. The second is the urticaria-edema form with characteristic skin symptoms.
Among the symptoms of the respiratory tract, the most common are:
– chronic sinusitis,
– rhinitis with a watery runny nose,
– numerous polyps in the nose,
– impaired sense of smell combined with nasal blockage,
– tearing, sneezing and pain around the forehead and ears.
The most common symptoms concerning the skin and mucous membranes are:
Swelling of the lips and tongue
– laryngeal edema,
Itchy skin
– hives.
How to recognize it?
Diagnosing aspirin-induced asthma is not difficult for a doctor. A detailed history regarding the circumstances of disturbing respiratory or skin symptoms is very important. The next step is to conduct research and oral aspirin challenge tests. It is extremely important that the provocation test is carried out in an outpatient clinic or hospital where there is a possibility of immediate resuscitation. This is important because as a result of aspirin intolerance, the larynx may even become swollen, and therefore stop breathing. Inhalation or intranasal provocation tests are safer for the patient, but diagnostic centers do not always have the appropriate preparations at their disposal.
Treatment of aspirin asthma
In patients hypersensitive to aspirin, bronchial asthma is usually more severe than in other patients, but the treatment does not differ from the standards used in the treatment of this disease.
In many cases, it is necessary for the patient to take glucocorticosteroids, which are administered not only by inhalation, but also orally. The success of treatment also depends on the diligence of patients who must strictly comply with the prohibition of taking painkillers and anti-inflammatory drugs acting through cyclooxygenase, i.e. an aspirin-like mechanism. You must not take unknown drugs, multi-ingredient preparations, especially those available without a prescription.
For your own safety, aspirin patients should have a list of the painkillers they can take with them and always inform their doctor or other health care professional if they are hypersensitive to aspirin and other NSAIDs.
Aspirin desensitization
An important procedure is desensitization, i.e. desensitization to aspirin. The procedure is based on the oral administration of increasing doses of aspirin. The first dose is minimal, i.e. one that will not cause a dangerous reaction in the body.
This therapy is somewhat similar to the desensitization that is used in allergen desensitization. However, this is not the same as aspirin-induced asthma is not an allergic disease. One thing that both treatments have in common is that they increase tolerance to a substance that previously caused serious symptoms.
Desensitization cannot be interrupted because even a few days without a dose of aspirin leads to a new hypersensitivity to the drug. When increasing the dose of aspirin at the beginning of desensitization, it is necessary to strictly adhere to the treatment regimen. Since there is a risk of side effects of aspirin, this method of treatment is used in selected cases, e.g. severe course of aspirin-induced asthma, recurrent nasal and sinus complications requiring surgical treatment. Desensitization is also used in patients who, due to another disease (e.g. rheumatoid arthritis), must take non-steroidal anti-inflammatory drugs.
Aspirin tolerance lasts on average for 2–5 days. Consequently, it is imperative that you take the maximum dose of aspirin (approximately 600 mg / day) daily to maintain this condition. A few days’ break in taking aspirin usually leads to a return of hypersensitivity, and re-taking it may result in an acute asthma attack. As a rule, achieving tolerance to aspirin leads to good tolerance of other NSAIDs by the patient.
Be careful
Patients with aspirin-induced asthma must absolutely avoid aspirin and its derivatives, as well as many other non-steroidal analgesic and anti-inflammatory drugs. Particular caution is advised in the administration of hydrocortisone semisuccinate and in the use of drugs, cosmetics, and the consumption of foods and drinks containing tatrazine – the yellow dye, as there are known cases of asthma attacks in patients with aspirin after contact with these substances.
If the feeling of breathlessness appeared or increased after taking aspirin or other aspirin-like medicine – the patient should inform the doctor about this fact.
Hypersensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) lasts for life.
It matters what you eat
A daily diet is also important for patients with aspirin-induced asthma. Foods that may contain dyes, preservatives and salicylates should be eliminated.
Foods rich in salicylates include:
– most herbs, especially mint, thyme, tarragon, rosemary, dill, sage, oregano, marjoram, basil, celery and sesame seeds,
– most spices, mainly anise, turkish pepper, cinnamon, cumin, curry powder, fenugreek, nutmeg, mustard, paprika and turmeric,
– most fruits – apples, blackberries, cherries, raisins, grapes, currants, nectarines, oranges, peaches, apricots, plums, prunes, raspberries, strawberries, cucumbers, tomatoes except bananas, peeled pears, pomegranates, mangoes and papaya ,
– most vegetables except cabbage, Brussels sprouts, bean sprouts, celery, leeks, green lettuce and peas.
Especially rich in salicylates are:
– cucumbers, olives and endives,
– potato peelings, but not the potatoes themselves,
– sweet corn, sweet potatoes,
– almonds, peanuts, Brazil nuts, macadamia nuts, pistachios and walnuts, and coconuts and anchorage (water nut),
– coffee, tea, coca-cola and mint tea,
– fruit juices, most alcoholic beverages (except vodka and gin), honey, licorice, mint candies,
– products rich in yeast,
– tomato sauce, Worcester sauce,
– lots of processed and prepared food.
Short salicylate content have:
– meat, fish and crustaceans,
– milk, cheese and eggs,
– wheat, rye, oats, barley and rice.