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Low dose intranasal lysine-aspirin in patients with aspirin-sensitive nasal polyps
S198 Abstracts
Low Dose Intranasal Lysine-Aspirin in Patients With AspirinSensitive Nasal Polyps A. A. Parikh1, G. K. Scadding2; 1Dept. of Otolaryngology, St. Mary’s Hospital, London, UNITED KINGDOM, 2Dept. of Rhinology, Royal National Throat, Nose & Ear Hospital, London, UNITED KINGDOM. RATIONALE: Intranasal lysine-aspirin is a potential alternative to oral desensitization in patients with aspirin-sensitive nasal polyposis. Uncritical trials have suggested its effectiveness1,2. We have undertaken the first scientifically controlled trial. METHODS: Randomized, double blind, placebo controlled, crossover trial using low dose (8mgs) intranasal lysine-aspirin (LAS) in polyp patients who reacted positively to nasal challenge with lysine aspirin. Nasal polyp size was measured using acoustic rhinometry. Patients maintained a daily diary of nasal and chest scores, nasal inspiratory peak flow (NIPF) and peak expiratory flow rate (PEFR). No other polyp therapy was permitted. RESULTS: Nine patients completed both phases. Multivariate analysis did not show any significant difference between the placebo or LAS phase. Volume and minimal cross sectional area changes were similar in both phases (p=.587, p=.774). Diary scores were similar (nasal score, p=.82; chest score p=.82; NIPF, p=.44; PEFR, p=.95). CONCLUSIONS: Low dose intranasal lysine-aspirin over 6 months is not effective in reducing polyp growth, but does not adversely affect asthma. However, nasal biopsies showed a significant reduction in CysLT1 receptor expression following LAS3. This suggests that desensitization occurs at a molecular level, but translation into clinical benefit may require more prolonged LAS use, possibly at higher doses as part of combined therapy. References 1. Patriarca, G et al. Annals of Allergy 67:588-589, 1991. 2. Nucera, E et al. Thorax 55(suppl 2):S75-S78, 2000. 3. Sousa, AR et al. New England Journal of Medicine 347(19):1493-1499, 2002. Funding: Not applicable
687
J ALLERGY CLIN IMMUNOL FEBRUARY 2004
MONDAY
Low Dose Intranasal Lysine-Aspirin in Patients With AspirinSensitive Nasal Polyps A. A. Parikh1, G. K. Scadding2; 1Dept. of Otolaryngology, St. Mary’s Hospital, London, UNITED KINGDOM, 2Dept. of Rhinology, Royal National Throat, Nose & Ear Hospital, London, UNITED KINGDOM. RATIONALE: Intranasal lysine-aspirin is a potential alternative to oral desensitization in patients with aspirin-sensitive nasal polyposis. Uncritical trials have suggested its effectiveness1,2. We have undertaken the first scientifically controlled trial. METHODS: Randomized, double blind, placebo controlled, crossover trial using low dose (8mgs) intranasal lysine-aspirin (LAS) in polyp patients who reacted positively to nasal challenge with lysine aspirin. Nasal polyp size was measured using acoustic rhinometry. Patients maintained a daily diary of nasal and chest scores, nasal inspiratory peak flow (NIPF) and peak expiratory flow rate (PEFR). No other polyp therapy was permitted. RESULTS: Nine patients completed both phases. Multivariate analysis did not show any significant difference between the placebo or LAS phase. Volume and minimal cross sectional area changes were similar in both phases (p=.587, p=.774). Diary scores were similar (nasal score, p=.82; chest score p=.82; NIPF, p=.44; PEFR, p=.95). CONCLUSIONS: Low dose intranasal lysine-aspirin over 6 months is not effective in reducing polyp growth, but does not adversely affect asthma. However, nasal biopsies showed a significant reduction in CysLT1 receptor expression following LAS3. This suggests that desensitization occurs at a molecular level, but translation into clinical benefit may require more prolonged LAS use, possibly at higher doses as part of combined therapy. References 1. Patriarca, G et al. Annals of Allergy 67:588-589, 1991. 2. Nucera, E et al. Thorax 55(suppl 2):S75-S78, 2000. 3. Sousa, AR et al. New England Journal of Medicine 347(19):1493-1499, 2002. Funding: Not applicable
687
J ALLERGY CLIN IMMUNOL FEBRUARY 2004
MONDAY