Role of leukotrienes in aspirin-induced asthma

Aspirin-induced asthma (AIA) is a well-defined clinical syndrome that affects about 10% of adult asthmatics and in which aspirin and several other non-steroidal anti-inflammatory drugs (NSAID) precipitate asthmatic reactions1-4. Although the onset of symptoms before puberty or after the age of 60 has been well documented, in most patients the first symptoms appear during the third or fourth decade of life. Typically, the patient experiences intense vasomotor rhinitis characterized by intermittent and profuse watery rhinorrhoea. Over a period of months or years, chronic nasal congestion appears and physical examination reveals nasal polyps. Bronchial asthma and intolerance to aspirin develop subsequently. The intolerance presents as a unique picture: within an hour after ingestion of aspirin an acute asthma attack develops, often accompanied by rhinorrhoea, conjunctival irritation and scarlet flushing of the head and neck. Aspirin is a common precipitating factor of life-threatening attacks of asthma5; in a recent large survey, 25% of asthmatic patients requiring emergency mechanical ventilation were found to be aspirin intolerant6.