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KEYSTONE, COLO – Pancreatitis may be a rare complication of aspirin desensitization therapy – and perhaps actually not so rare – in patients with aspirin-exacerbated respiratory disease.
"Be aware: If you’re doing desensitization and a patient reports severe abdominal pain, please check the pancreatic enzyme levels," Dr. Rohit K. Katial urged at a meeting on allergy and respiratory diseases sponsored by National Jewish Health.
He and his coworkers were the first to describe this novel complication in a report detailing three cases. Two occurred during the 2-day aspirin desensitization procedure, with pancreatic lipase levels of 425 and 789 U/L, respectively, with normal defined as 13-63 U/L. The third involved a subacute presentation beginning 4 days after finishing desensitization, with a lipase level of 207 U/L while the patient was on standard postdensensitization high-dose aspirin therapy at 650 mg b.i.d. (J. Allergy Clin. Immunol. 2012;129:1684-6).
Gallbladder disease, alcohol, drugs, and other secondary causes of pancreatitis were ruled out in all three cases, noted Dr. Katial, professor of medicine at the University of Colorado, Denver, and director of allergy and immunology clinical services at National Jewish Health.
This previously unreported close temporal association between pancreatitis and aspirin desensitization is of particular interest because it may actually not be all that uncommon. Indeed, other investigators, in a study of 172 aspirin-desensitized patients, reported that 27% of them discontinued high-dose maintenance aspirin therapy during the first year. The most common reason for doing so was the emergence of epigastric pain, accounting for 14 discontinuations. Another two patients discontinued therapy because of GI bleeding (J. Allergy Clin. Immunol. 2003;111:180-6).
These gastrointestinal reactions weren’t extensively investigated, since it’s well known that high-dose aspirin is associated with gastritis and peptic ulcer disease. So it’s quite possible that some of these cases of what was classified clinically as gastritis were actually pancreatitis, according to Dr. Katial.
The mechanism involved in pancreatitis in the setting of aspirin desensitization is unknown. Animal studies suggest the marked increase in leukotriene levels occurring during aspirin desensitization may play a role. Even though all three patients were on prophylactic montelukast (Singulair) at the time of aspirin challenge, the leukotriene receptor antagonist may not provide complete protection in a subset of vulnerable patients.
Dr. Katial reported serving as an adviser to and on the speakers bureau for Teva Pharmaceuticals.
KEYSTONE, COLO – Pancreatitis may be a rare complication of aspirin desensitization therapy – and perhaps actually not so rare – in patients with aspirin-exacerbated respiratory disease.
"Be aware: If you’re doing desensitization and a patient reports severe abdominal pain, please check the pancreatic enzyme levels," Dr. Rohit K. Katial urged at a meeting on allergy and respiratory diseases sponsored by National Jewish Health.
He and his coworkers were the first to describe this novel complication in a report detailing three cases. Two occurred during the 2-day aspirin desensitization procedure, with pancreatic lipase levels of 425 and 789 U/L, respectively, with normal defined as 13-63 U/L. The third involved a subacute presentation beginning 4 days after finishing desensitization, with a lipase level of 207 U/L while the patient was on standard postdensensitization high-dose aspirin therapy at 650 mg b.i.d. (J. Allergy Clin. Immunol. 2012;129:1684-6).
Gallbladder disease, alcohol, drugs, and other secondary causes of pancreatitis were ruled out in all three cases, noted Dr. Katial, professor of medicine at the University of Colorado, Denver, and director of allergy and immunology clinical services at National Jewish Health.
This previously unreported close temporal association between pancreatitis and aspirin desensitization is of particular interest because it may actually not be all that uncommon. Indeed, other investigators, in a study of 172 aspirin-desensitized patients, reported that 27% of them discontinued high-dose maintenance aspirin therapy during the first year. The most common reason for doing so was the emergence of epigastric pain, accounting for 14 discontinuations. Another two patients discontinued therapy because of GI bleeding (J. Allergy Clin. Immunol. 2003;111:180-6).
These gastrointestinal reactions weren’t extensively investigated, since it’s well known that high-dose aspirin is associated with gastritis and peptic ulcer disease. So it’s quite possible that some of these cases of what was classified clinically as gastritis were actually pancreatitis, according to Dr. Katial.
The mechanism involved in pancreatitis in the setting of aspirin desensitization is unknown. Animal studies suggest the marked increase in leukotriene levels occurring during aspirin desensitization may play a role. Even though all three patients were on prophylactic montelukast (Singulair) at the time of aspirin challenge, the leukotriene receptor antagonist may not provide complete protection in a subset of vulnerable patients.
Dr. Katial reported serving as an adviser to and on the speakers bureau for Teva Pharmaceuticals.
KEYSTONE, COLO – Pancreatitis may be a rare complication of aspirin desensitization therapy – and perhaps actually not so rare – in patients with aspirin-exacerbated respiratory disease.
"Be aware: If you’re doing desensitization and a patient reports severe abdominal pain, please check the pancreatic enzyme levels," Dr. Rohit K. Katial urged at a meeting on allergy and respiratory diseases sponsored by National Jewish Health.
He and his coworkers were the first to describe this novel complication in a report detailing three cases. Two occurred during the 2-day aspirin desensitization procedure, with pancreatic lipase levels of 425 and 789 U/L, respectively, with normal defined as 13-63 U/L. The third involved a subacute presentation beginning 4 days after finishing desensitization, with a lipase level of 207 U/L while the patient was on standard postdensensitization high-dose aspirin therapy at 650 mg b.i.d. (J. Allergy Clin. Immunol. 2012;129:1684-6).
Gallbladder disease, alcohol, drugs, and other secondary causes of pancreatitis were ruled out in all three cases, noted Dr. Katial, professor of medicine at the University of Colorado, Denver, and director of allergy and immunology clinical services at National Jewish Health.
This previously unreported close temporal association between pancreatitis and aspirin desensitization is of particular interest because it may actually not be all that uncommon. Indeed, other investigators, in a study of 172 aspirin-desensitized patients, reported that 27% of them discontinued high-dose maintenance aspirin therapy during the first year. The most common reason for doing so was the emergence of epigastric pain, accounting for 14 discontinuations. Another two patients discontinued therapy because of GI bleeding (J. Allergy Clin. Immunol. 2003;111:180-6).
These gastrointestinal reactions weren’t extensively investigated, since it’s well known that high-dose aspirin is associated with gastritis and peptic ulcer disease. So it’s quite possible that some of these cases of what was classified clinically as gastritis were actually pancreatitis, according to Dr. Katial.
The mechanism involved in pancreatitis in the setting of aspirin desensitization is unknown. Animal studies suggest the marked increase in leukotriene levels occurring during aspirin desensitization may play a role. Even though all three patients were on prophylactic montelukast (Singulair) at the time of aspirin challenge, the leukotriene receptor antagonist may not provide complete protection in a subset of vulnerable patients.
Dr. Katial reported serving as an adviser to and on the speakers bureau for Teva Pharmaceuticals.
EXPERT ANALYSIS FROM THE PULMONARY AND ALLERGY UPDATE
