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Aspirin-induced asthma
Aspirin-induced asthma is also termed Samter's triad, Samter's syndrome, aspirin-exacerbated respiratory disease (AERD),〔Allergy. 2013 Oct;68(10):1219-32. doi: 10.1111/all.12260〕 and recently by an appointed task force of the European Academy of Allergy and Clinical Immunology/World Allergy Organization (EAACI/WAO) Non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD).〔Allergy. 2013 Oct;68(10):1219-32. doi: 10.1111/all.12260〕 The syndrome, which EAACI/WHO classifies as one of 5 types of non-steroidal anti-inflammatory drug hypersensitivity or NSAID hypersensitivity reactions, is a medical condition initially defined as consisting of three key features viz., asthma, symptom evocation by aspirin, and nasal/ethmoidal polyposis; however, the syndrome's symptoms are evoked by a large variety of other NSAID besides aspirin and rhinitis is an important accompaniment to, and often the earliest manifestation of, AERD.〔Clin Chest Med. 1988 Dec;9(4):567-76〕〔Allergy. 2011 Jul;66(7):818-29. doi: 10.1111/j.1398-9995.2011.02557〕 The asthma and rhinitis components of this syndrome are hypersensitivity reactions to NSAID rather than true allergic reactions that trigger common allergen-induced asthmatic and rhinitis responses; the syndrome does not appear to involve, for example, the common mediators of allergen-induced disease, immunoglobulin E or T cells.〔 Rather, aspirin-induced asthma is a subtype of NSAID-induced non-allergic syndromes that include NSAID-induced urticaria/angioedema associated with underlying chronic urticaria, NSAID-induced urticaria/angioedema not associated chronic urticarial, and various other types of typically delayed (i.e. more than 1 day post-exposure) pathological responses to NSAID such as bullous or maculopapular skin eruptions, contact dermatitis, photocontact dermatitis, pneumonitis, and aseptic meningitis.〔 It should be noted, however, that about 10% of patients with AERD manifest urticaria and/or angioedema reactions to NSAID.〔
== Signs and symptoms ==
The various non-allergic NSAID hypersensitivity syndromes affect 0.5-1.9% of the general population, with aspirin-intolerant asthma affecting up to 0.3 percent of the general population and, when tested by aspirin provocation, up to 21% of asthmatics without nasal polyps and 25.6% of asthmatics with nasal polyps.〔〔Am J Rhinol. 2006 Nov-Dec;20(6):573-6.〕 AERD, which is more prevalent in women, usually begins in young adulthood〔(【引用サイトリンク】accessdate=2014-12-13 )〕 (twenties and thirties are the most common onset times although children are afflicted with it and present a diagnostic problem in pediatrics)〔Int J Pediatr Otorhinolaryngol. 2013 Feb;77(2):281-3. doi: 10.1016/j.ijporl.2012.10.017〕 and may not include any other allergies. Most commonly the first symptom is rhinitis (inflammation or irritation of the nasal mucosa), which can manifest as sneezing, runny nose, or congestion. The disorder typically progresses to asthma, then nasal polyposis, with aspirin sensitivity coming last. Anosmia (lack of smell) is also common, as inflammation within the nose and sinuses likely reaches the olfactory receptors.〔Clin Rev Allergy Immunol. 2003 Apr;24(2):113-24〕
The reactions to aspirin vary in severity, ranging from mild nasal congestion and eye watering to lower respiratory symptoms including wheezing, coughing, an asthma attack, anaphylaxis, and in rare cases urticaria. In addition to aspirin, patients usually also react to other NSAIDs such as ibuprofen, and to any medication that inhibits the cyclooxygenase-1 (COX-1) enzyme, although paracetamol (acetaminophen) in low doses is generally considered safe. NSAID that are highly selective in blocking COX-2 and do not block its closely related paralog, COX-1, such as the COX-2 inhibitors celecoxib and rofecoxib, are also regarded as safe.〔Lancet Neurol. 2008 Sep;7(9):812-26. doi: 10.1016/S1474-4422(08)70169-8〕 Nonetheless, recent studies do find that these types of drugs, e.g. acetaminophen and celecoxib, may trigger adverse reactions in these patients; caution is recommended in using any COX inhibitors.〔Allergy Asthma Immunol Res. 2014 Mar;6(2):156-62. doi: 10.4168/aair.2014.6.2.156〕 In addition to aspirin and NSAIDs, consumption of even small amounts of alcohol also produces uncomfortable respiratory reactions in many patients.
抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』
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