Dietary Fatty Acid Modification for the Treatment of Aspirin-Exacerbated Respiratory Disease: A Prospective Pilot Trial

Abstract

The high levels of eicosanoid production and the clinical efficacy of leukotriene-modifying pharmacotherapies for patients with aspirin-exacerbated respiratory disease (AERD) suggest that other interventions targeting arachidonic acid dysregulation may also improve disease control. To assess the utility of a high omega-3/low omega-6 diet for the treatment of AERD. Prospective, nonblinded dietary intervention in 10 adult patients with AERD at Brigham and Women's Hospital in Boston, MA. The primary objective was for subjects to reduce dietary omega-6 fatty acid consumption to less than 4 g/d and increase omega-3 intake to more than 3 g/d. The primary outcome was change in urinary leukotriene E4, with changes in other eicosanoids, platelet activation, lung function, and patient-reported questionnaires also assessed. Of the 10 subjects who screened for the study, all 10 completed the dietary intervention. Urinary leukotriene E4 decreased by 0.17 ng/mg (95% CI,-0.29 to-0.04; P= .02) and tetranor prostaglandin D-M decreased by 0.66 ng/mg creatinine (95% CI,-1.21 to-0.11; P= .02). There was a 15.1-point reduction in the 22-item Sino-Nasal Outcome Test score (95% CI,-24.3 to-6.0; P= .01), a 0.27-point reduction in the 7-item Asthma Control Questionnaire score (95% CI,-0.52 to-0.03; P= .03), and no change in FEV1 % predicted (P=.92) or forced vital capacity % predicted (P=.74). All patients lost some weight over the 2-week intervention period, and there were no diet-associated adverse events. A high omega-3/low omega-6 diet may be an appropriate adjunct treatment option for patients with AERD.