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A 42-year-old white male presents to your office complaining of periodic breathing difficulty and wheezing. He visited an otolaryngologist for persistent nasal blockage recently. His past medical history is significant for unstable angina experienced five months ago. His current treatment includes aspirin, diltiazem, and pravastatin. He does not use tobacco, alcohol, or drugs. His vital signs are within limits. What is the most probable cause of this patient™s respiratory complaints?
A. IgE-mediated reaction
B. Immune complex disease
C. Cytotoxic antibodies
D. Cell-mediated hypersensitivity
E. Pseudo-allergic reaction
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it is e. well done !!!
expl:
The most probable diagnosis in this patient is aspirin sensitivity syndrome. The clues to the correct diagnosis include aspirin ingestion, persistent nasal blockage, and episodes of bronchoconstriction. The pathogenesis of aspirin sensitivity syndrome is believed to involve ˜pseudo-allergic reaction,™ that is an exaggerated release of vasoactive and inflammatory mediators in susceptible individuals. Aspirin is a cyclooxygenase (COX-1 and COX-2) inhibitor. As the result of its pharmacologic action, arachidonate diverges from blocked COXs to a
5-lipoxygenase pathway. Accumulation of leukotrienes and changed prostaglandin/leukotriene balance triggers characteristic reactions (bronchoconstriction, polyp formation) in susceptible individuals. Leukotriene inhibitors are gaining popularity in the treatment of this condition. Other commonly used treatment modalities include topical corticosteroids and aspirin desensitization therapy.
IgE-mediated reaction (Choice A) and immune-complex disease (Choice B) are important in the pathogenesis of some asthmatic conditions. Cytotoxic antibodies (Choice C) and cell-mediated hypersensitivity (Choice D) have limited role in the pathogenesis of asthma.
