Effect of low salicylate diet on clinical and inflammatory markers in patients with aspirin exacerbated respiratory disease \u2013 a randomized crossover trial

Leigh J Sowerby,Crystal Schmerk,Krupal B Patel,Doron D Sommer,Brian W Rotenberg,Taciano Rocha

doi:10.1186/s40463-021-00502-4

Abstract

BackgroundAspirin-exacerbated respiratory disease (AERD) is characterized by eosinophilic rhinosinusitis, nasal polyposis, and bronchial asthma, along with the onset of respiratory reactions after the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA). In addition to the therapeutic routines and surgical options available, a low dietary intake of food salicylate has been suggested as adjunctive therapy for this condition.This study aimed to assess the influence of a short-term low salicylate diet on inflammatory markers in patients with AERD and whether that would result in symptomatic improvement.MethodsProspective study with randomization to either a high or low salicylate diet for 1 week, followed by cross-over to the other study arm. Participants were asked to record their dietary salicylate for each week of the study. Urinary creatinine, salicylate and leukotriene levels were measured at the time of recruitment, end of week one and end of week two and the SNOT-22 questionnaire was filled out at the same time points.ResultsA total of seven participants completed the study. There was no statistical difference in the urinary salicylate and leukotriene levels between the two diets; nevertheless, participants on low salicylate diet reported improved SNOT-22 symptoms scores (p = 0.04), mainly in the rhinologic, ear/facial, and sleep dysfunction symptom domains. In addition, these last two domains outcomes were more significant than the minimal clinically important difference.ConclusionsA short-term low salicylate diet may not result in biochemical outcomes changes but seems to provide significant symptomatic relief for patients with AERD.Trial registrationNCT01778465 (www.clinicaltrials.gov)Graphical abstract

Highlights

Aspirin-exacerbated respiratory disease (AERD) is characterized by eosinophilic rhinosinusitis, nasal polyposis, and bronchial asthma, along with the onset of respiratory reactions after the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA)
Aspirin exacerbated respiratory disease (AERD) is an acquired condition with a median age of onset around 30 years, that consists of bronchial asthma, chronic rhinosinusitis with nasal polyposis and hypersensitivity to acetylsalicylic acid (ASA) [1, 2]
Patients with a history of surgery for chronic rhinosinusitis with nasal polyposis, confirmed asthma, and a documented history of a significant respiratory sensitivity reaction to ASA or ibuprofen were invited to participate in the study

Summary

Introduction

Aspirin-exacerbated respiratory disease (AERD) is characterized by eosinophilic rhinosinusitis, nasal polyposis, and bronchial asthma, along with the onset of respiratory reactions after the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA). Aspirin exacerbated respiratory disease (AERD) is an acquired condition with a median age of onset around 30 years, that consists of bronchial asthma, chronic rhinosinusitis with nasal polyposis and hypersensitivity to acetylsalicylic acid (ASA) [1, 2]. In AERD patients, acetylsalicylic acid (ASA) intolerance is a non-allergic hypersensitivity reaction without immunoglobulin E (IgE) involvement. These patients have recalcitrant chronic rhinosinusitis with nasal polyposis (CRSwNP), often requiring frequent surgical intervention, systemic corticosteroid therapy and aspirin desensitization [2, 3]. Altered metabolism of arachidonic acid results in an imbalance of prostaglandins (PG) and leukotrienes (LT), eliciting increased levels of cysteinyl leukotrienes (CysLT) and decreased levels of prostaglandin E2 (PGE2) [4].

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