Effect of low salicylate diet on clinical and inflammatory markers in patients with aspirin exacerbated respiratory disease - a randomized crossover trial

Leigh J Sowerby, Krupal B Patel, Crystal Schmerk, Brian W Rotenberg, Taciano Rocha, Doron D Sommer, Leigh J Sowerby, Krupal B Patel, Crystal Schmerk, Brian W Rotenberg, Taciano Rocha, Doron D Sommer

Abstract

Background: Aspirin-exacerbated respiratory disease (AERD) is characterized by eosinophilic rhinosinusitis, nasal polyposis, and bronchial asthma, along with the onset of respiratory reactions after the ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA). In addition to the therapeutic routines and surgical options available, a low dietary intake of food salicylate has been suggested as adjunctive therapy for this condition. This study aimed to assess the influence of a short-term low salicylate diet on inflammatory markers in patients with AERD and whether that would result in symptomatic improvement.

Methods: Prospective study with randomization to either a high or low salicylate diet for 1 week, followed by cross-over to the other study arm. Participants were asked to record their dietary salicylate for each week of the study. Urinary creatinine, salicylate and leukotriene levels were measured at the time of recruitment, end of week one and end of week two and the SNOT-22 questionnaire was filled out at the same time points.

Results: A total of seven participants completed the study. There was no statistical difference in the urinary salicylate and leukotriene levels between the two diets; nevertheless, participants on low salicylate diet reported improved SNOT-22 symptoms scores (p = 0.04), mainly in the rhinologic, ear/facial, and sleep dysfunction symptom domains. In addition, these last two domains outcomes were more significant than the minimal clinically important difference.

Conclusions: A short-term low salicylate diet may not result in biochemical outcomes changes but seems to provide significant symptomatic relief for patients with AERD.

Trial registration: NCT01778465 ( www.clinicaltrials.gov ).

Keywords: Aspirin sensitivity; Asthma; Chronic rhinosinusitis; Immune system diseases; Nasal polyps.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study Flow Diagram
Fig. 2
Fig. 2
CysLT variation post High and Low Salicylate diets
Fig. 3
Fig. 3
SNOT 22 score variation post High and Low Salicylate diets
Fig. 4
Fig. 4
Inter-group analysis of SNOT 22 results in 5 domains. Dotted lines represent the minimal clinically important difference (MICD) for each domain [13]. Asterisks express the Mann-Whitney test with a 2-tailed significance ≤ .05

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