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Cheng S, Xu X, Kong X, Jiang Y, Mo L, Li M, Jin Y, Han Y, Li XL, Jin T, Min JZ. Monitoring of salicylic acid content in human saliva and its relationship with plasma concentrations. J Pharm Biomed Anal 2022; 219:114961. [PMID: 35907319 DOI: 10.1016/j.jpba.2022.114961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022]
Abstract
Aspirin is a widely used anti-inflammatory drug. It is reported that a relationship may exist between salicylic acid content in plasma and saliva after taking aspirin. This study established a rapid, convenient, and safe method to assess salicylic acid concentration in human saliva. A novel HPLC-ultraviolet detector was used to measure salicylic acid concentrations in human saliva and plasma. A C18 reversed-phase column with an aqueous solution of 0.1% trifluoroacetic acid (TFA)-acetonitrile mobile phase was used, and drug peaks were recorded at 303 nm. Salicylic acid was completely separated in saliva and plasma. Excellent linearity and correlation (r2 ≥ 0.9999) was observed between 0.1 and 2.0 μg/mL. The detection limit (S/N = 3) was 33 ng/mL, and intra- and inter-day recoveries were 103.5-113.3% and 101.1-109.5%, respectively. Salicylic acid was measured within nine hours after administration of acetylsalicylic acid tablets. A positive correlation between salicylic acid content in saliva and plasma was found (r = 0.867, p < 0.001). The proposed method was used successfully to measure salicylic acid concentration in human saliva. Meanwhile, we explored the relationship between salicylic acid levels in plasma and saliva. Saliva might replace blood for monitoring aspirin treatment. In addition, the research provides a reference for application to saliva samples.
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Affiliation(s)
- Shengyu Cheng
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China
| | - Xianglin Xu
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China
| | - Xinxin Kong
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China
| | - Yudi Jiang
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China
| | - Luxuan Mo
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China
| | - Mingxia Li
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China
| | - Yueying Jin
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China
| | - Yu Han
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China
| | - Xi-Ling Li
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China
| | - Toufeng Jin
- Department of General Surgery Yanbian University Hospital, Yanji 133002, Jilin Province, China.
| | - Jun Zhe Min
- Key Laboratory of Natural Medicines of the Changbai Mountain, Ministry of Education, Pharmaceutical Analysis, College of Pharmacy Yanbian University, Yanji 133002, Jilin Province, China.
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Talat R, Gengler I, Phillips KM, Caradonna DS, Gray ST, Sedaghat AR. Chronic Rhinosinusitis Outcomes of Patients With Aspirin-Exacerbated Respiratory Disease Treated With Budesonide Irrigations: A Case Series. Ann Otol Rhinol Laryngol 2021; 131:1130-1136. [PMID: 34775833 DOI: 10.1177/00034894211054948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pathophysiology-targeting treatments exist for aspirin-exacerbated respiratory disease (AERD) through aspirin desensitization and biologics, such as dupilumab. With increasing attention paid to these treatments, which may be associated with significant side effects and/or cost, there is little description of chronic rhinosinusitis with nasal polyps (CRSwNP) response to treatment with intranasal corticosteroids and saline irrigations in AERD. OBJECTIVE To determine the effect of intranasal budesonide irrigations for the treatment of CRSwNP in AERD. METHODS This is an observational study of 14 AERD patients presenting to a rhinology clinic for CRS who were treated with twice daily high volume, low pressure irrigations with 240 mL of saline to which a 0.5 mg/2 mL respule of budesonide was added. All participants completed a 22-item Sinonasal Outcome Test (SNOT-22) at enrollment and at follow up 1 to 6 months later. Polyp scores were also calculated at each time point. RESULTS SNOT-22 scores ranged from 26 to 98 (median: 40.5) at enrollment and 3 to 85 (median: 38.5) at follow-up. Polyp scores ranged from 2 to 6 (median: 4) at enrollment at 0 to 6 (median: 2) at follow-up. Over the treatment period, change in SNOT-22 score ranged from -38 to 16 (median: -18) and change in polyp score ranged from -2 to 0 (median: -0.5). Approximately 57% of participants experienced at least 1 minimal clinically important difference in SNOT-22 score and 21% of participants had a SNOT-22 score <20 at follow-up. CONCLUSION Medical management with intranasal corticosteroids and saline irrigations alone leads to significant improvement in sinonasal symptomatology in a subset of AERD.
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Affiliation(s)
- Rehab Talat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Isabelle Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David S Caradonna
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Division of Otolaryngology, Boston, MA, USA
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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San Nicoló M, Habermann N, Havel M. AERD Associated Nasal Polyposis: Efficacy of Postoperative Antileukotriene Therapy in Comparison with Aspirin Desensitization. A Retrospective Study. Int Arch Allergy Immunol 2020; 181:790-798. [PMID: 32777782 DOI: 10.1159/000508708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/15/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AERD (aspirin-exacerbated respiratory disease) is a severe form of an inflammatory disease of the upper airway system. Therapy remains challenging due to a complex underlying pathophysiology. OBJECTIVE To evaluate the efficacy of postoperative antileukotriene therapy concerning recurrence of nasal polyposis in patients with AERD and to compare it with AD (aspirin desensitization) over time. METHODS In this retrospective study we analyzed AERD patients (N = 61) after functional endoscopic sinus surgery (FESS). Patients were treated at our institution postoperatively with topical mometasone (control group, N = 22), leukotriene-receptor-antagonists (montelukast [MT], N = 18) or underwent an aspirin desensitization (N = 21). Subjective parameters as assessed by SNOT (sinonasal outcome test) questionnaire and endoscopic endonasal examination (polyposis grading) were evaluated throughout a follow-up period of 6-9 and >12 (long-term) months after surgery. RESULTS Endoscopic endonasal examinations 6-9 months after sinus surgery showed a good disease control in all 3 groups with significant reduction in polyp grading in the AD group. After a follow-up period of more than 12 months, MT and AD patients had significantly less polyp recurrences as compared to the topical treatment group. Subjective sinonasal symptoms revealed that hyposmia and nasal obstruction were prominent factors in all 3 groups throughout the follow-up period. MT group showed significant improvement in sinonasal symptoms over time. CONCLUSION Postoperative treatment with leukotriene-receptor-antagonists and aspirin desensitization both significantly reduce nasal polyp recurrence. MT has a positive effect on subjective sinonasal outcomes and patients' quality of life over time.
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Affiliation(s)
- Marion San Nicoló
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany,
| | - Nicole Habermann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Miriam Havel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
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White AA, Doherty TA. Role of group 2 innate lymphocytes in aspirin-exacerbated respiratory disease pathogenesis. Am J Rhinol Allergy 2018; 32:7-11. [PMID: 29336282 DOI: 10.2500/ajra.2018.32.4498] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aspirin-exacerbated respiratory disease (AERD) is characterized by chronic eosinophilic nasal polyps, asthma, and airway reactions upon cyclooxygenase (COX) 1 inhibition. AERD is present in up to 7% of adult patients with asthma and the underlying pathogenesis remains largely elusive but prostaglandin D2, cysteinyl leukotrienes, mast cells, and type 2 cytokines are thought to contribute. A wealth of studies have recently implicated group 2 innate lymphoid cells (ILC2), a novel lineage-negative lymphocyte population that produces type 2 cytokines, in human allergic disease pathogenesis. Importantly, our recent work identified that ILC2s are recruited to the nasal mucosa of patients on AERD after COX-1 inhibitor administration. Here, we review the potential impact of ILC2s in the development and propagation of type 2 inflammation in AERD.
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Affiliation(s)
- Andrew A White
- From the Divison of Allergy, Asthma and Immunology, Scripps Clinic, La Jolla, California
| | - Taylor A Doherty
- Department of Medicine, University of California, San Diego, La Jolla, California
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Walters KM, Waldram JD, Woessner KM, White AA. Long-term Clinical Outcomes of Aspirin Desensitization With Continuous Daily Aspirin Therapy in Aspirin-exacerbated Respiratory Disease. Am J Rhinol Allergy 2018; 32:280-286. [PMID: 29682983 DOI: 10.1177/1945892418770260] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Aspirin-exacerbated respiratory disease (AERD), also known as Samter's triad or aspirin (ASA)-intolerant asthma, affects 7% of asthmatics and has a higher prevalence in those with chronic rhinosinusitis and concomitant nasal polyposis. ASA desensitization with daily ASA therapy is a uniquely beneficial treatment for this disease entity and has been shown to have a significant impact on symptom scores, polyp disease, and need for systemic corticosteroids. However, no long-term studies have demonstrated whether or not ASA therapy remains safe and beneficial for these patients beyond 5-10 years. Objective This study was designed to determine the clinical course of AERD patients desensitized between 1995 and 2010. Methods A 20-question survey was distributed to patients who successfully completed ASA desensitization between January 1995 and April 2010. The questions were designed to assess ASA safety and longitudinal effects of ASA therapy in AERD. Results Of the 285 patients contacted, 92 (32%) completed the questionnaire. Average length of follow-up was 15 years. Of survey responders, 35 patients had discontinued ASA therapy. Although adverse reactions occurred, many also discontinued due to lack of efficacy or need for surgery. For those remaining on ASA (62%), significant improvement in sense of smell, asthma, sinus, and allergic rhinitis scores were noted ( P ≤ .001). The majority of ASA patients (68%) had a positive response to treatment and did not require further sinus surgery. However, ASA therapy did not delay the time to next sinus/polyp surgery ( P = .27) or reduce total number of sinus surgeries ( P = .56) compared to those who stopped treatment. Nearly 85% of AERD patients on ASA therapy found it to be helpful in improving airway disease and quality of life. Conclusion Aspirin desensitization followed by daily maintenance ASA therapy appears to be safe and effective even after 10+ years of continuous use.
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Affiliation(s)
- Kristen M Walters
- 1 Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California
| | - Jeremy D Waldram
- 1 Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California
| | - Katharine M Woessner
- 1 Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California
| | - Andrew A White
- 1 Department of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California
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Stevens W, Buchheit K, Cahill KN. Aspirin-Exacerbated Diseases: Advances in Asthma with Nasal Polyposis, Urticaria, Angioedema, and Anaphylaxis. Curr Allergy Asthma Rep 2016; 15:69. [PMID: 26475526 DOI: 10.1007/s11882-015-0569-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aspirin-exacerbated diseases are important examples of drug hypersensitivities and include aspirin-exacerbated respiratory disease (AERD), aspirin- or non-steroidal anti-inflammatory drug (NSAID)-induced urticaria/angioedema, and aspirin- or NSAID-induced anaphylaxis. While each disease subtype may be distinguished by unique clinical features, the underlying mechanisms that contribute to these phenotypes are not fully understood. However, the inhibition of the cyclooxygenase-1 enzyme is thought to play a significant role. Additionally, eosinophils, mast cells, and their products, prostaglandins and leukotrienes, have been identified in the pathogenesis of AERD. Current diagnostic and treatment strategies for aspirin-exacerbated diseases remain limited, and continued research focusing on each of the unique hypersensitivity reactions to aspirin is essential. This will not only advance the understanding of these disease processes, but also lead to the subsequent development of novel therapeutics that patients who suffer from aspirin-induced reactions desperately need.
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Affiliation(s)
- Whitney Stevens
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, Suite 1000, Chicago, IL, 60611, USA.
| | - Kathleen Buchheit
- Division of Rhematology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, 1 Jimmy Fund Way, Smith Building Room 638, Boston, MA, 02115, USA.
| | - Katherine N Cahill
- Division of Rhematology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, 1 Jimmy Fund Way, Smith Building Room 638, Boston, MA, 02115, USA.
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Rozsasi A, Heinemann A, Keck T. Release of cyclooxygenase-2 and lipoxin A4 from blood leukocytes in aspirin-exacerbated respiratory disease. ALLERGY & RHINOLOGY 2016; 7:158-163. [PMID: 28107149 PMCID: PMC5244273 DOI: 10.2500/ar.2016.7.0172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The release of cyclooxygenase-2 (COX-2) and lipoxin A4 (LXA4) from blood mononuclear cells in patients with aspirin-exacerbated respiratory disease (AERD) is only partially understood. OBJECTIVE To investigate the presence of COX-2 and LXA4 in peripheral blood mononuclear cells (PBMC) derived from patients with AERD and with nasal polyps (NP) (designated as the AERD-NP group), patients with NP without AERD (the NP group), and healthy controls without sinus disease (the control group). METHODS Blood was taken from 14 patients in the AERD-NP group, 6 patients in the NP group, and 8 healthy subjects in the control group. After culturing of human PBMC, the presence of COX-2 protein and LXA4 (ELISA) was detected in the supernatant, and the results were compared among the groups. RESULTS COX-2 and LXA4 were detectable after culturing of PBMC in all patients in the AERD-NP and NP groups and in the control subjects. COX-2 was highest in the patients in the AERD-NP group, but the difference was not significant compared with patients with non-AERD polyp and with the control subjects. LXA4 was also highest in the AERD-NP group, but the difference was also not significant compared with the patients who were non-AERD polyp and the control subjects. CONCLUSION Neither the release of COX-2 or LXA4 was different between the patients with AERD and with NPs, the patients without AERD and with NPs, and the healthy control group. The release of these proteins in AERD needs further investigation.
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Affiliation(s)
- Ajnacska Rozsasi
- From the Department of Otorhinolaryngology, Head, Neck, and Facial Plastic Surgery, Elisabethinen Hospital, Academic Hospital of the Medical University of Graz, Graz, Austria, and
| | - Akos Heinemann
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Graz, Austria
| | - Tilman Keck
- From the Department of Otorhinolaryngology, Head, Neck, and Facial Plastic Surgery, Elisabethinen Hospital, Academic Hospital of the Medical University of Graz, Graz, Austria, and
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Li N, Peters AT. Chronic rhinosinusitis management beyond intranasal steroids and saline solution irrigations. Allergy Asthma Proc 2015; 36:339-43. [PMID: 26314815 DOI: 10.2500/aap.2015.36.3866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous disease with clinical manifestations that are influenced by the presence or absence of nasal polyposis. Understanding of the current and future treatment modalities for CRS is essential in preventing exacerbation and morbidity associated with this chronic condition. OBJECTIVE The aim of this article is to review the evidence behind current medical therapies and potential new treatments for CRS. METHODS Scientific literature regarding intranasal and systemic antibiotics, intranasal systemic corticosteroids, and monoclonal antibodies as interventions for CRS with and without nasal polyps was reviewed. RESULTS The literature supports the use of topical or systemic glucocorticoids in patients with nasal polyps, and there appears to be a role for systemic antibiotics in the treatment of acute exacerbations of CRS with nasal polyps. The response to corticosteroids or antibiotics in the treatment of exacerbations of CRS without nasal polyps is variable. Due to the lack of appropriately designed trials, there is weak evidence for the adjunctive use of immunotherapy at this time. Monoclonal antibodies that target Immunoglobulin E and T helper cell 2 cytokines have been clinically effective in symptom reduction for some patients with CRS with nasal polyps although further studies are needed. CONCLUSION Current therapies used in the treatment of CRS are discussed.
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Affiliation(s)
- Newton Li
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Suh JD. Editorial: Advances in the Diagnosis and Treatment of Patients with Chronic Rhinosinusitis and Allergy. Am J Rhinol Allergy 2015; 29:1-2. [DOI: 10.2500/ajra.2015.29.4158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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