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ASS-Intoleranz-Syndrom und persistierende Rhinosinusitis

Differentialdiagnostik und Therapie

ASA-intolerance syndrome and persistent rhinosinusitis

Differential diagnosis and treatment

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Zusammenfassung

Hintergrund

Der persistierenden chronischen Rhinosinusitis (CRS) kann, insbesondere wenn sie mit einer häufig rezidivierenden Polyposis nasi et sinuum, einem Asthma bronchiale und einer Überempfindlichkeitsreaktion auf Acetylsalicylsäure (ASS) und anderen nichtsteroidalen Antiphlogistika gemeinsam einhergeht, das Analgetika-Intoleranz-Syndrom (AIS) zu Grunde liegen. Die Pathogenese dieses Syndroms wird auf eine Fehlleitung des Arachidonsäurestoffwechsels mit der Folge einer erhöhten Leukotrienproduktion zurückgeführt.

Methoden

Die Diagnosestellung ist bei häufig unvollständiger Symptomtrias im Anfangsstadium der Erkrankung erschwert. Ziel sollte dennoch eine frühzeitige Einleitung einer spezifischen Therapie sein.

Ergebnisse

Zur Behandlung der CRS haben sich eine chirurgische Sanierung der Nasennebenhöhlen, eine antiinflammatorisch-medikamentöse Therapie und die adaptive Desaktivierung als einzige kausale Behandlungsmöglichkeit bewährt.

Schlussfolgerung

Die adaptive Desaktivierung zeigt nach aktueller Studienlage positive Effekte auch bei zuvor langwierigen rhinosinusitischen Beschwerden. Zusammen mit weiteren symptomorientierten Maßnahmen kann so eine Reduktion der sinunasalen Symptome erreicht werden.

Abstract

Background

A differential diagnosis of persistent chronic rhinosinusitis is ASA-intolerance syndrome (AIS), also known as Aspirin®‑exacerbated respiratory disease (AERD), Samter-Trias (Samter’s disease, Morbus Widal). Particularly in cases of frequent recurrency of nasal polyps in combination with bronchial asthma and hypersensitivity reactions to acetylsalicylic acid (ASA) and other nonsteroidal anti-inflammatory drugs (NSAR) can often be referred to an underlying AIS. The pathogenesis of this syndrome is attributed to a misallocation of the arachidonic acid metabolism, resulting in an increased leukotriene production.

Methods

The diagnosis may be difficult in the early stages of the disease with incomplete triad of symptoms.

Results

Therapy may consist of paranasal sinuses surgery, drug therapy and adaptive deactivation as the only causal treatment option for patients with AIS.

Conclusion

For adaptive desactivation, positive effects were actually shown even in patients with long-term recurrent or persistent complaints of chronic rhinosinusitis.

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Abbreviations

AIS:

Analgetika-Intoleranz-Syndrom

ASS:

Acetylsalicylsäure

CAST:

Cellular allergen stimulation test

CRS:

Chronische Rhinosinusitis

CRSwNP:

Chronic rhinosinusitis with nasal polyposis, Chronische Rhinosinusitis mit nasaler Polyposis

FESS:

Functional Endoscopic Sinus Surgery, funktionelle endoskopische Nasennebenhöhlenchirurgie

FET:

Funktioneller Eikosanoidtest

GKS:

Glukokortikosteroide

LRA:

Leukotrien-Rezeptor-Antagonist

nGKS:

Nasale Glukokortikosteroide

NNH:

Nasennebenhöhle

NSAR:

Nichtsteroidale Antiphlogistika

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  1. Universitätsklinikum Münster, Klinik für Hals-Nasen-Ohrenheilkunde, Kardinal-von-Galen-Ring 10, 48149, Münster, Deutschland

    H. Kirsche

  2. Zentrum für Rhinologie und Allergologie, Wiesbaden, Deutschland

    L. Klimek

  3. HNO-Universitätsklinik Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland

    L. Klimek

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Kirsche, H., Klimek, L. ASS-Intoleranz-Syndrom und persistierende Rhinosinusitis. HNO 63, 357–363 (2015). https://doi.org/10.1007/s00106-015-0008-7

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