Plasma 15-Hydroxyeicosatetraenoic Acid Predicts Treatment Outcomes in Aspirin-Exacerbated Respiratory Disease

J Allergy Clin Immunol Pract. 2017 Jul-Aug;5(4):998-1007.e2. doi: 10.1016/j.jaip.2016.11.021. Epub 2017 Jan 31.

Abstract

Background: Aspirin desensitization followed by daily aspirin provides therapeutic benefits to patients with aspirin-exacerbated respiratory disease (AERD). It is not well understood how eicosanoid levels change during aspirin treatment.

Objective: To investigate associations between clinical outcomes of aspirin treatment and plasma eicosanoid levels in patients with AERD.

Methods: Thirty-nine patients with AERD were offered aspirin treatment (650 mg twice daily) for 4 weeks. Respiratory parameters and plasma levels of multiple eicosanoids were recorded at baseline and after 4 weeks of aspirin therapy using the Asthma Control Test and Rhinoconjunctivitis Quality of Life Questionnaire. Respiratory function was evaluated using the FEV1 and nasal inspiratory peak flow.

Results: After aspirin treatment, respiratory symptoms improved in 16 patients, worsened in 12 patients, and did not change in 4 patients. Seven patients were unable to complete the desensitization protocol. Patients with symptom improvement had higher baseline plasma 15-hydroxyeicosatetraenoic acid (15-HETE) levels than did patients with symptom worsening: 7006 pg/mL (interquartile range, 6056-8688 pg/mL) versus 4800 pg/mL (interquartile range, 4238-5575 pg/mL), P = .0005. Baseline 15-HETE plasma levels positively correlated with the change in Asthma Control Test score (r = 0.61; P = .001) and in FEV1 after 4 weeks of aspirin treatment (r = 0.49; P = .01). It inversely correlated with Rhinoconjunctivitis Quality of Life Questionnaire score (r = -0.58; P = .002). Black and Latino patients were more likely to have symptom worsening on aspirin or fail to complete the initial desensitization than white, non-Latino patients (P = .02).

Conclusions: In patients with AERD, low baseline 15-HETE plasma levels and black or Latino ethnicity are associated with worsening of respiratory symptoms during aspirin treatment.

Keywords: 15-hydroxyeicosatetraenoic acid; Aspirin desensitization; Aspirin-exacerbated respiratory disease; Eicosanoids; Eosinophils.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aspirin / therapeutic use*
  • Asthma, Aspirin-Induced / blood*
  • Asthma, Aspirin-Induced / ethnology
  • Asthma, Aspirin-Induced / physiopathology
  • Asthma, Aspirin-Induced / therapy*
  • Black People
  • Cyclooxygenase Inhibitors / therapeutic use*
  • Desensitization, Immunologic*
  • Female
  • Forced Expiratory Volume
  • Hispanic or Latino
  • Humans
  • Hydroxyeicosatetraenoic Acids / blood*
  • Male
  • Middle Aged
  • Treatment Outcome

Substances

  • Cyclooxygenase Inhibitors
  • Hydroxyeicosatetraenoic Acids
  • 15-hydroxy-5,8,11,13-eicosatetraenoic acid
  • Aspirin