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Aspirin-exacerbated respiratory disease: an update

Le Pham, Duy; Lee, Ji-Ho; Park, Hae-Sim

Current Opinion in Pulmonary Medicine: January 2017 - Volume 23 - Issue 1 - p 89–96
doi: 10.1097/MCP.0000000000000328
ASTHMA: Edited by Nicola A. Hanania and Zuzana Diamant
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Purpose of review The pathophysiology of aspirin-exacerbated respiratory disease (AERD) is not fully understood and diagnostic methods and so far, treatments for AERD have not been standardized. We summarize recent research into the pathological mechanisms of AERD, diagnostic methods, and treatments for AERD patients.

Recent findings In AERD pathophysiology, not only the reduced expression of E prostanoid 2 but also the dysfunction of its pathway could be involved. Moreover, eosinophils of AERD patients could be directly activated by aspirin to produce prostaglandin D2. Platelet activations are well known to be involved in AERD; however, plasma markers do not change during aspirin challenge tests. Additionally, novel genetic polymorphisms, such as P2RY12 and dipeptidyl peptidase 10 gene, and epigenetic predispositions of AERD were found. In AERD diagnosis, bronchial and nasal aspirin challenges have been applied in addition to oral challenge. Serum periostin has been suggested as a potential biomarker for AERD. Apart from standard pharmacological treatment and aspirin desensitization, biologics, including omalizumab and mepolizumab, as well as CRTH2 antagonists have been suggested as promising therapies for AERD treatment.

Summary AERD is usually associated with severe asthma phenotypes. AERD pathophysiology mainly involves the dysregulation of eicosanoid metabolisms, activations of effector cells, which could be influenced by genetic/epigenetic factors. Understanding the pathophysiology of AERD is key to improve the diagnostic methods and proper management of AERD patients.

aDepartment of Allergy and Clinical Immunology, Ajou University School of Medicine

bDepartment of Biomedical Sciences, Ajou University School of Medicine, Suwon, South Korea

cFaculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam

Correspondence to Hae-Sim Park, MD, PhD, Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si 443-380, South Korea. Tel: +82 31 219 5150; fax: +82 31 219 5154; e-mail: hspark@ajou.ac.kr

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