Sinus surgery improves lower respiratory tract reactivity during aspirin desensitization for AERD

Aspirin desensitization followed by maintenance therapy with daily high-dose aspirin has been used clinically to control symptoms in patients with aspirin-exacerbated respiratory disease (AERD) since the early 1980s.1 Prospective studies have demonstrated that treatment with high-dose aspirin leads to long-term improvements in upper and lower respiratory tract symptoms as well as reduction in corticosteroid requirement in patients with AERD.2,3 Although generally safe, aspirin challenges and desensitizations do carry a risk of precipitating severe asthma attacks and occasionally systemic reactions. In the literature, leukotriene receptor antagonists such as montelukast are reported to reduce the severity of lower respiratory tract reactions and have mixed efficacy in reducing aspirin-induced upper airway reactions during aspirin desensitization.5,6 Therefore, it is common practice for patients to be premedicated with montelukast before aspirin desensitization. The rationale for this is 2-fold: (1) high-dose aspirin maintenance after FESS can delay or obviate the need for revision sinus surgery and prolong the benefits of surgery for these patients and (2) aspirin use is contraindicated during FESS and desensitization would need to be repeated following surgical intervention.7,8 Recently, Jerschow et al9 reported that, in a predominantly African-American and Hispanic/Latino population, aspirin-induced reactions were less severe during desensitizations that occurred shortly after FESS.