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Stellenwert von ASS-Provokationen beim Analgetika-Intoleranz-Syndrom

Importance of aspirin challenges in patients with NSAID-exacerbated respiratory disease

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Zusammenfassung

Hintergrund

Das Analgetika-Intoleranz-Syndrom (AIS) ist häufig durch schwere Verläufe der chronischen Rhinosinusitis mit nasaler Polyposis (CRSwNP) mit komorbidem Asthma und einer Acetylsalicylsäure(ASS)-Intoleranz gekennzeichnet. Bei Intoleranzreaktionen stellen ASS-Provokationen den Goldstandard der Diagnostik dar. Expertenempfehlungen zufolge liegt ein AIS bei plausibler positiver Anamnese von Intoleranz gegenüber nichtsteroidalen Antirheumatika (NSAR) und einer CRSwNP mit Asthma vor.

Ziel der Arbeit

Im vorliegenden Review wird die Durchführung von ASS-Provokationen sowie deren Sensitivität und Spezifität dargestellt. Des Weiteren wird untersucht, inwieweit eine positive NSAR-Intoleranz-Anamnese mit Ergebnissen von ASS-Provokationen in klinischen Studien übereinstimmt und wann ASS-Provokationen erfolgen sollten.

Ergebnisse und Schlussfolgerung

ASS-Provokationen weisen eine hohe Sensitivität und Spezifität auf. In klinischen ASS-Provokationsstudien zeigt sich eine hohe Übereinstimmung zwischen einer von Rhinologen erhobenen positiven NSAR-Intoleranz-Anamnese und den Messdaten von ASS-Provokationen bei Patienten mit einer CRSwNP und einem komorbiden Asthma. Somit sind ASS-Provokationen vorrangig bei unklarer NSAR-Intoleranz-Anamnese indiziert.

Abstract

Background

Nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) is often characterized by a severe course of chronic rhinosinusitis with nasal polyps (CRSwNP), comorbid asthma, and NSAID hypersensitivity. The gold standard for N-ERD diagnosis is challenge with acetylsalicylic acid (ASA). In expert recommendations, the diagnosis of N-ERD is established based on a plausible positive history of NSAID hypersensitivity and CRSwNP with asthma.

Objective

The following review describes the performance of ASA challenges and their sensitivity and specificity. It also examines the extent to which a positive history of NSAID hypersensitivity correlates with ASA challenge results in clinical trials and when ASA challenges should be performed.

Results and conclusion

ASA challenges have high sensitivity and specificity. In clinical ASA challenge studies, there is a high concordance between a positive history of NSAID hypersensitivity obtained by rhinologists and the measured data of ASA challenge in patients with CRSwNP and comorbid asthma. Therefore, ASA challenge is primarily indicated in patients with an unclear history of NSAID hypersensitivity.

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Abbreviations

AIS:

Analgetika-Intoleranz-Syndrom

ASA:

Acetylsalicylic acid

ASS:

Acetylsalicylsäure

BPT:

Bronchialer Provokationstest

COX:

Cyclooxygenase

CRS:

Chronische Rhinosinusitis

CRSsNP:

Chronische Rhinosinusitis ohne Nasenpolypen

CRSwNP:

Chronische Rhinosinusitis mit Nasenpolypen

FEV1:

Forciertes exspiratorisches Volumen 1

IL:

Interleukin

LT:

Leukotriene

N‑ERD:

NSAID-exacerbated respiratory disease

NNH-Op:

Nasennebenhöhlen-Operation

NPT:

Nasaler Provokationstest

NSAID:

„Nonsteroidal anti-inflammatory drug“

NSAR:

Nichtsteroidale Antirheumatika

OPT:

Oraler Provokationstest

PG:

Prostaglandin

PNIF:

Peak nasal inspiratory flow

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Authors and Affiliations

  1. HNO-Klinik, Charité – Universitätsmedizin Berlin (CCM/CVK), Charitéplatz 1, 10117, Berlin, Deutschland

    Ulrike Förster-Ruhrmann & Heidi Olze

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  1. Ulrike Förster-Ruhrmann
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  2. Heidi Olze
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Correspondence to Ulrike Förster-Ruhrmann.

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U. Förster-Ruhrmann und H. Olze geben an, dass kein Interessenkonflikt besteht.

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Förster-Ruhrmann, U., Olze, H. Stellenwert von ASS-Provokationen beim Analgetika-Intoleranz-Syndrom. HNO (2024). https://doi.org/10.1007/s00106-024-01460-9

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