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Genetics of aspirin induced asthma

Aspirin induced asthma (AIA) is more common in women than in men. The first symptoms of the disease are often a viral respiratory infection which is followed by a prolonged and perennial rhinitis.1 Nasal congestion, anosmia, and rhinorrhoea are accompanied by nasal polyps which are found on physical examination in about half the patients. Within a few years bronchial asthma develops, characterised by aspirin intolerance. Aspirin precipitates life threatening attacks of asthma accompanied by rhinorrhoea, conjunctive congestion, and facial and neck flushing. The trait of aspirin sensitivity, despite avoidance of non-steroidal anti-inflammatory drugs to which patients usually have cross sensitivity, frequently remains for the patient's lifetime.

Although asthma, nasal polyps, and aspirin intolerance are considered as an inherited disease in the catalogue of Mendelian Inheritance in Man ,2reports on familial occurrence of AIA are rather scarce. Miller described a pair of sisters with the trait.3 In one of the families described by Lockey et al 4 consanguinity of the parents suggested a recessive inheritance pattern. In the other family a late onset of AIA and discordance between identical twins raised the possibility of an interaction between environmental and genetic factors. Another multiple family with mild asthma sensitive aspirin and dominant inheritance of the trait was described by von Maur et al .5 An early onset of asthma in most affected members of the family and a lack of symptoms of sinusitis or nasal polyposis distinguished this familial variant of AIA.

In almost 400 patients studied in the European Network on Aspirin Induced Asthma6 familial occurrence of aspirin hypersensitivity was reported in 5.1%. In families with multiple cases of AIA, affected individuals were usually siblings. The course of their disease was characterised by an intense rhinitis and was more severe, as scored by the number …