Nasal symptoms in patients with NSAID hypersensitivity

Background : Approximately 1 to 2% of the general population suffers from nonsteroidal anti-inflammatory drugs (NSAID) hypersensitivity. NSAID hypersensitivity is closely associated with concomitant respiratory disease. Exact knowledge of sino-nasal symptoms among patients with NSAID hypersensitivity is important as patients with NSAID hypersensitivity are at risk of having underdiagnosed, undertreated chronic rhinosinusitis with affected QoL. The aim of this study was to estimate the prevalence of chronic rhinosinusitis in patients with NSAID hypersensitivity and to evaluate QoL and the need of ENT intervention. Methodology : Patients with confirmed NSAID hypersensitivity at the Allergy Centre were referred to the Department of Otorhinolaryngology for evaluation by an ENT specialist. All patients completed the Sino Nasal Outcome test 22 (QoL) and underwent nasal endoscopy and smell test. Results : A total of 46 patients with NSAID hypersensitivity participated in ENT evaluation. Chronic rhinosinusitis was diagnosed in 19 patients. The mean Sino Nasal Outcome test 22 score was 39 in patients with chronic rhinosinusitis and 17 in patients without chronic rhinosinusitis. The sense of smell was decreased in patients with chronic rhinosinusitis. Nasal steroid was indicated in 22 patients. Seven patients had former sinus surgery and 10 patients underwent new sinus or nasal surgery. Conclusion : With a prevalence of 41% more than one third of patients with NSAID hypersensitivity have chronic rhinosinusitis with decreased QoL. In patients with sino-nasal problems medical and surgical advice and treatment is important. It is recommended that patients with NSAID hypersensitivity are screened for sino-nasal symptoms and referred for ENT evaluation.