Systemic responses after bronchial aspirin challenge in sensitive patients with asthma

Background

In aspirin-sensitive patients with asthma, bronchial obstruction induced by oral aspirin may be associated with extrabronchial symptoms, suggesting the systemic character of the response.

Objective

Go assess potential systemic effects of local aspirin challenge, hemopoietic progenitors were measured in the peripheral blood of challenged patients.

Methods

In 19 patients with a history of aspirin-induced asthma, placebo-controlled bronchial challenges with lysine-aspirin were performed. Peripheral blood was collected before and then 1 hour and 20 hours after challenge (placebo or aspirin). Using the flow-cytometric method, the numbers of leukocyte (CD34⁺ cells) and eosinophil (CD34⁺CD125⁺ cells) progenitors were determined.

Results

The challenge was positive in 13 patients; 6 patients had isolated local bronchial reaction, and 7 patients developed systemic symptoms (bronchial and extrabronchial). In patients with positive challenge (n = 13), leukocyte progenitors increased significantly at 1 hour and 20 hours after challenge (mean, 0.04% at baseline, 0.066% at 1 hour after challenge, and 0.073% at 20 hours; P < .05). Eosinophil progenitors raised significantly from mean 0.017% before challenge to 0.04% (P < .05) at 20 hours after the challenge. At 20 hours after the challenge, the increase in leukocyte and eosinophil progenitors was observed only in patients with systemic reactions. Positive aspirin challenge was associated with a significant increase in eotaxin 2 serum concentration.

Conclusion

This study demonstrated that bronchial challenge with aspirin may involve systemic reactions and is associated with mobilization of leukocyte and eosinophil progenitor cells from the bone marrow.

Key words: Aspirin hypersensitivity, bronchial asthma, AERD, progenitor cells, CD34, aspirin bronchial challenge

Abbreviations used: EP, Eosinophil progenitor, LP, Lymphocyte progenitor, NSAID, Nonsteroidal anti-inflammatory drug