Acasa > Reviste de specialitate > Alergologia > Boala respiratorie exacerbată de antiinflamatoare nesteroidiene (N-ERD) în populaţia pediatrică
RUBRICA SPECIALISTULUI

Boala respiratorie exacerbată de antiinflamatoare nesteroidiene (N-ERD) în populaţia pediatrică

 Non-steroidal anti-inflammatory drug exacerbated respiratory disease (N-ERD) in the pediatric population

Mădălina Coman-Stanemir, Camelia Elena Berghea

First published: 31 octombrie 2023

Editorial Group: MEDICHUB MEDIA

DOI: 10.26416/Aler.7.3.2023.8789

Abstract

Non-steroidal anti-inflammatory drug exacerbated respiratory disease (N-ERD) is predominantly encountered in adults and rarely documented and less well-defined clinically and epidemiologically in children. The cause remains unclear, with the main pathogenic mechanism being represented by a decrease in prostaglandin E2 production, increased production of cysteinyl-leukotrienes, and eosinophilic inflammation. N-ERD symptoms in the pediatric population are similar to those in adults: chronic eosinophilic rhinosinusitis with nasal polyps, asthma and respiratory symptoms upon aspirin/NSAID administration, but they can initially present with gastrointestinal or cutaneous symptoms or be more subtle, making early diagnosis difficult and requiring rigorous differential diagnosis.
Pediatric onset of N-ERD should be considered by specialists when faced with cases of asthma associated with chronic rhinosinusitis and nasal polyps. Studies involving a larger number of patients are needed to determine the frequency of non-steroidal anti-inflammatory drug hypersensitivity in children with asthma and to establish the evolutionary and therapeutic characteristics of this patient category.

Keywords
NSAID-exacerbated respiratory disease, pediatric asthma, chronic rhinosinusitis with nasal polyps in children

Rezumat

Boala respiratorie exacerbată de antiinflamatoare nesteroidiene (N-ERD) este întâlnită predominant la adulţi şi rareori documentată şi mai puţin bine definită din punct de vedere clinic şi epidemiologic la copii. Cauza rămâne neclară, principalul mecanism patogenic fiind reprezentat de scăderea producţiei de prostaglandină E2, producţia crescută de cisteinil-leucotriene şi inflamaţie eozinofilică. Simptomele N-ERD în populaţia pediatrică sunt similare celor întâlnite la adult: rinosinuzită cronică eozinofilică cu polipoză nazală, astm şi simptome respiratorii la administrarea de aspirină/AINS, dar pot îmbrăca şi un tablou iniţial gastrointestinal, cutanat sau mai subtil, ceea ce face ca diagnosticul precoce să fie dificil, obligând la un diagnostic diferenţial riguros.
Debutul pediatric al N-ERD trebuie luat în considerare de specialişti în faţa cazurilor de astm care asociază rinosinuzită cronică şi polipoză nazală. Sunt necesare studii care să implice un număr mai mare de pacienţi pentru a determina frecvenţa hipersensibilităţii la antiinflamatoare nesteroidiene la copiii cu astm, pentru a stabili caracteristicile evolutive şi terapeutice ale acestei categorii de pacienţi.

Cuvinte cheie
boală respiratorie exacerbată de AINS astm pediatric rinosinuzită cronică cu polipoză nazală la copil

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