Mepolizumab Does Not Prevent All Aspirin-Induced Reactions in Patients with Aspirin-Exacerbated Respiratory Disease: A Case Series

Abstract

Aspirin-exacerbated respiratory disease (AERD) is a triad including nasal polyposis, asthma, and NSAID sensitivity. The effects of anti-IL-5 treatment on the severity of aspirin-induced reactions are unknown. This was a retrospective chart review of patients with AERD in our clinic who had undergone aspirin desensitization while on treatment with mepolizumab. Two Caucasian females and one black female, ages 38-49, with AERD and previously reported respiratory reactions to NSAIDs, underwent oral aspirin desensitization after being treated with mepolizumab for 3-13 months. The patients’ AERD had been diagnosed 2-25 years prior with 1-2 sinus surgeries prior to the desensitization. Patient #1 developed an aspirin-induced reaction that consisted of nasal congestion, headache, itching, and rhinorrhea with a drop in FEV1 of 12% (baseline of 1.81L). Patient #2’s aspirin reaction consisted of wheezing on lung exam with no change in her baseline FEV1 of 1.84L and the development of hives and pruritus of her upper body. Patient #3’s aspirin reaction consisted of pruritus, nasal congestion, wheezing on lung exam with a drop in her FEV1 of 11% (baseline of 2.22L), and protracted severe abdominal pain and vomiting, for which IM Epinephrine was administered and a tryptase, drawn 7 hours after the onset of symptoms, was 19 ng/ml. Based on this case series, we conclude that patients with AERD who are on anti-IL-5 treatment with mepolizumab can still develop aspirin-induced reactions, including severe and systemic symptoms. Further controlled research is warranted to determine if anti-IL-5 treatment may lessen or change the reaction symptoms.