Among patients with aspirin-exacerbated respiratory disease (AERD), there appears to be a gradual progression from asthma to nasal polyps and then to aspirin sensitivity, according to study results reported in the International Forum of Allergy and Rhinology. Whereas upper and lower airway disease are often initially recognized in AERD, drug sensitivity commonly occurs almost a year after the initial diagnosis.

Researchers selected deidentified data of patients with AERD who were included in the MarketScan Database between 2009 and 2015. The search of the MarketScan Database yielded 5628 patients who met the inclusion criteria (mean age, 46 years). Patients had International Classification of Diseases-9th Edition codes for asthma (n=3303), nasal polyposis (n=1408), and general drug allergy (n=917). The time of first occurrence for each diagnosis was analyzed.

In 36% of patients, the most common sequence of diagnoses reported was asthma, then nasal polyps, followed by drug allergy. Only 6% of patients had a timeline sequence of diagnoses in the reverse order. The median time between diagnosis of either upper or lower airway involvement, including nasal polyps and/or asthma, to identification of drug sensitivity was 259 days (quartiles Q1-Q3, 92-603 days).

Among patients who did not have an initial drug allergy and who had both asthma and nasal polyp diagnoses prior to April 1, 2015, the risk for drug sensitivity was 6% during the study period.

Limitations of the study were the reliance on physician coding and documentation in the MarketScan database, the lack of chart review for the dataset, as well as the lack of a specific diagnostic code for AERD.

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“An earlier diagnosis of aspirin sensitivity with avoidance of triggers or aspirin desensitization may dampen the progression of disease,” the researchers wrote.

Disclosure: A study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Roland LT, Wang H, Mehta CC, et al. Longitudinal progression of aspirin-exacerbated respiratory disease: analysis of a national insurance claims database [published online August 23, 2019]. Int Forum Allergy Rhinol. doi:10.1002/alr.22412