Association of urinary leukotriene E 4 excretion during aspirin challenges with severity of respiratory responses

Abstract

Background: Asthmatics with aspirin- (ASA) sensitive respiratory disease (ASRD) have a spectrum of respiratory reactions during oral ASA challenge that vary in severity and are temporally associated with leukotriene (LT) formation. Objective: This study investigates the relationship of the severity of ASA-induced respiratory reactions to urinary LTE 4 excretion. Methods: Asthmatics with suspected ASRD underwent oral ASA challenges. Urinary LTE 4 levels were measured at baseline, during the reaction, and after acute ASA desensitization. Results: Asthmatics who had respiratory reactions during oral ASA challenges were divided into 3 groups: asthmatics with naso-ocular reactions and <15% decline from baseline FEV 1 values (group 1), asthmatics with a decline in FEV 1 of 20% to 30% (group 2), and asthmatics with a decline in FEV 1 of >30% (group 3). There were no significant differences in age, baseline FEV 1 values, use of inhaled corticosteroids, daily prednisone doses, prednisone bursts, duration of reactions, or average provoking doses of ASA among the groups. At baseline group 3 asthmatics had significantly higher urinary LTE 4 levels than those in groups 1 or 2. At the time of respiratory reaction to ASA, the urinary LTE 4 levels rose significantly in all groups but were significantly greater among group 3 asthmatics compared with those in groups 1 and 2. Conclusion: The severity of the respiratory reactions during oral ASA challenges was associated with the degree of elevation of baseline LTE 4 synthesis. Our results suggest that asthmatics with ASRD have a spectrum of respiratory tract reactions in which leukotrienes play a distinguishing role. (J Allergy Clin Immunol 1999;104:559-64.)