The following article is a part of conference coverage from the American Academy of Allergy, Asthma & Immunology Virtual Annual Meeting, being held virtually from February 26 to March 1, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the AAAAI 2021 Virtual Annual Meeting.


A small team of researchers have generated a scoring system that assesses lower respiratory and extra-respiratory symptoms and better monitors aspirin-induced reaction severity in patients with aspirin-exacerbated respiratory disease (AERD), according to study findings presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Virtual Annual Meeting held February 26 to March 1, 2021.

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Patients with AERD have 3 primary clinical features that do not typically respond to conventional therapies: nasal polyposis, asthma, and respiratory reactions to cyclooxygenase-1 inhibitors. In addition, some patients may experience extra-respiratory, gastrointestinal, and cutaneous symptoms in association with increased serum tryptase. While currently available scoring systems can assess upper airway symptoms during desensitization, they generally do not assess lower respiratory or extra-respiratory symptoms.

A total of 30 patients with AERD in this study underwent a standardized oral aspirin challenge. The investigators collected the participants’ total nasal symptom score (TNSS), spirometry, urine, and serum at baseline as well as at the onset of a respiratory reaction and the following 3 hours. In addition, the investigators included 4 questions with the TNSS to generate the TNSS+, focusing on both the presence and severity of headache, gastrointestinal, cutaneous, and lower respiratory symptoms (scale of 0-5).

The investigators sought to determine the Spearman correlation (rS) between the maximum increase in symptom score and the maximum change in urinary leukotriene (uLT)E4, prostaglandin D2 metabolite (uPGD-M), and serum tryptase levels from baseline. A clinical reaction following the oral aspirin challenge was observed in 29 patients. The maximum change in the TNSS+ was associated with the maximum change in uLTE4 (rS=0.411; P =.03), uPGD-M (rS=0.522; P =.004), and serum tryptase (rS=0.378; P =.057). There was no significant correlation between the TNSS and mediator production.

“The TNSS+ may be useful to standardize the assessment of reaction severity in future clinical and research settings,” the study authors concluded.


Staso P, Wu P, Laidlaw T, Cahill K. Assessing systemic symptoms during aspirin challenge in aspirin exacerbated respiratory disease (AERD). Presented at: the American Academy of Allergy, Asthma & Immunology (AAAAI) Virtual Annual Meeting; February 26=March 1, 2021. Abstract 121.

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