Aspirin Intolerance

Disturbances of the arachidonic acid metabolism, resulting in a pathologic eicosanoid shift, represent a common pathway in the pathophysiologic spectrum of chronic rhinosinusitis. Patients suffering from nasal polyposis and aspirin intolerance (AI) have a high risk of markedly increased long-term recurrence rates after surgical therapy. AI is always associated with a significant eicosanoid shift that can be successfully addressed by oral aspirin desensitization. A low-dose desensitization regime reduces the adverse effects of aspirin and is necessary to achieve favorable clinical results along with long-term compliance. Pathologic expression of cyclooxygenase isoenzymes and their interaction with growth factors like vascular endothelial growth factor may play a relevant role in nasal polyp growth in both aspirin-intolerant and aspirin-tolerant patients.