Allergy and Immunology
Review Corner

Allergy and Immunology Review Corner: Chapter 93 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Questions prepared by Dr. Soo Hee Kim-Delio, Walter Reed Army Medical Center. 

Chapter 93: Sensitivity to Aspirin and Non-steroidal Anti-inflammatory Drugs

1. Which is a true statement about AERD?
A. Aspirin induces the disease
B. Sensitivity refers to a single type of reaction
C. Avoidance of ASA/NSAIDs does not change the course of the respiratory disease
D. A single type of NSAID may inhibits COX-1 and improves respiratory symptoms

2. In which clinical setting should the clinician be most suspicious of AERD?
A. An asthmatic patient with relentless formation of nasal polyps and pansinusitis
B. Rhinosinusitis
C. Pan-sinusitis and asthma
D. Polyps alone

3. Which of the following statements about ASA/NSAIDs and chronic idiopathic urticaria is true?
A. Avoidance of ASA/NSAIDs in patients with chronic idiopathic urticaria does not eliminate the acute flares
B. Avoidance in patients with CIU appears to alter the course of the disease
C. The more quiescent the underlying urticaria, the more likely it is that ASA/NSAIDs will cause urticarial exacerbation
D. The more active the underlying urticaria, the more likely it is that ASA/NSAIDs will cause urticarial exacerbation

4. What do leukotriene modifier drugs appear to do during oral ASA challenges in patients with AERD?
A. Diminish the capacity of the challenges to induce nasoocular reactions
B. Protect the lower respiratory tract without diminishing the capacity of the challenges to induce nasoocular reactions
C. Increase the capacity of the challenges to induce nasoocular reactions
D. Not affect the capacity of the challenges to induce nasoocular reactions

5. Which of the following medications prevented most ASA induced respiratory reactions, presumably by interfering with the interaction of ASA and COX-1?
A. Clemastine
B. Sodium salicylate
C. Leukotriene modifier drugs
D. Systemic corticosteroids

6. Which of the following statements about ASA desensitization is true?
A. All AERD patients can be desensitized to ASA
B. Desensitization to ASA in patients with chronic idiopathic urticaria is possible to sustain
C. After desensitization, without any further meds, the desensitized state lasts about seven days
D. After desensitization, without any further meds, full sensitization returns after two to five days

7. BAL fluid from AERD asthmatics contained higher concentrations of which substances compared to ASA tolerant controlled asthmatics?
A. LTE4
B. LTD4 and TXB2
C. PGE2
D. LTC4 and TXB2

8. In nasal polyp tissue, which cells were found to have delayed apoptosis in AERD patients compared to ASA tolerant asthmatics?
A. Mast cells
B. PMNs
C. Eosinophils
D. T-cells

9. What are the most debilitating components of AERD?
A. Rhinosinusitis and nasal polyps
B. Asthma activity
C. Sinus infection
D. Ocular pruritis

10. ASA induced reactions require inhibition of which substance based on cross-reactivity of AERD patients to structurally distinct NSAIDs on first exposure?
A. Arachadonic acid
B. COX-2
C. COX-1
D. LTC4 synthase

Answers:
1. C, page 1697
2. A, page 1697
3. D, page 1697
4. B, page 1697
5. B, page 1697
6. A, page 1700
7. D, page 1701
8. C, page 1702
9. A, page 1706
10. C, page 1703