Das Analgetika-Asthma-Syndrom

Zusammenfassung

Eine wichtige Differenzialdiagnose von Polyposis nasi, Intrinsic Asthma oder Urtikaria ist die Analgetika-Intoleranz. Die Begriffe „Analgetika-Asthma-Syndrom“ oder „Aspirin-exacerbated Respiratory Disease“ (AERD) fassen den Symptomenkomplex von chronischer Rhinosinusitis, Polyposis nasi, Asthma bronchiale und Unverträglichkeitsreaktion ausgelöst durch nicht-steroidale Antirheumatika (NSAR, NSAID) zusammen. Betroffen sind überwiegend Frauen ab der dritten Lebensdekade. Die Krankheitszeichen an der Nase manifestieren sich oft Jahre vor dem Asthma und einer Intoleranzreaktion. Nicht selten erfolgen wiederholt operative Entfernungen der Nasenpolypen, die jedoch meist nach kurzer Zeit rezidivieren. Das Asthma ist häufig nur schwer zu kontrollieren und steroidpflichtig. Die Erkrankung hat ihre Ursache keineswegs in der Einnahme von NSAID, die Unverträglichkeit stellt ein Epiphänomen der zugrundeliegenden biochemischen Störung dar. Sie beruht nicht auf einer allergischen, also IgE-vermittelten Reaktion, sondern auf einer Überproduktion der Cysteinyl-Leukotriene im Arachidonsäuremetabolismus der Zelle. Daher bleiben Hauttests oder spezifische Antikörper immer negativ. Es liegen neuere Daten zu In-vitro-Untersuchungen vor, die eine Analgetika-Intoleranz bestätigen und differenzieren lassen. Dennoch ist die nasale, inhalative und orale Provokationstestung weiter der diagnostische Goldstandard. Im Mittelpunkt der Therapie steht die adaptive Desaktivierung, die häufig eine Verbesserung der nasalen Symptomatik und teilweise eine Stabilisierung des Asthmas ermöglicht.

Abstract

Aspirin sensitivity is an important underlying disease in patients with nasal polyps, intrinsic asthma or urticaria. The terms “Aspirin- (or analgetics-) induced asthma” or “Aspirin-exacerbated respiratory disease“ (AERD) describe the syndrome of chronic rhinosinusititis, polyposis nasi, asthma and acute reaction after ingestion of non-steroid antiinflammatory drugs (NSAID). The disease affects mainly women in the third decade or older. Nasal symptoms often appear many years previous to asthma and acute intolerance reactions. Nasal polyps not rarely require surgical interventions. However, polyps often relapse after weeks or few months after resection. The intrinsic asthma is difficult to control and patients often require treatment with oral steroids. The disease is not caused by the ingestion of NSAID, the sensitivity represents a phenomenon of the underlying metabolic disorder. Aspirin sensitivity is not an allergic disease based on IgE-mediated reactions. In contrast it is due to a metabolic overexpression of cysteinyl leucotrienes. Thus, skin tests and specific antibodies in the blood are always negative. Recent studies indicate that NSAID sensitivity may be proven and differentiated by sophisticated in vitro tests. However, nasal, bronchial, and oral provocation testing remains the standard of diagnosis. Aspirin desensitization is the most relevant therapeutical approach which improves nasal symptoms in the majority of patients and may stabilize intrinsic asthma.

Schlüsselwörter

Analgetika-Asthma-Syndrom - Asthma bronchiale - Analgetika-induziertes Asthma - chronische Rhinosinusitis - Polyposis nasi

Keywords

Aspirin-exacerbated respiratory disease - bronchial asthma - analgetics-induced asthma - chronic rhinosinusititis - nasal polyposis

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