Asthma Allergy Immunology

Asthma Allergy Immunology

2010, Vol 8, Num, 3     (Pages: 189-192)

Aspirin-sensitive asthma aggrevation after toothpaste use

Mehmet HOXHA 1, Eriola PİLURİ 1, Eris MESONJËSİ 1, Alfred PRİFTANJİ 1,

1 Department of Allergology and Clinical Immunology, University Hospital Center: “Mother Teresa” Tirana, Albania

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Hypersensitivity to aspirin is present in 5-10% of asthmatic patients and is associated with chronic rhinosinusitis and nasal polyposis, a syndrome referred to, recently as Aspirin-exacerbated respiratory disease. Menthol (oil of peppermint) is often used as flavoring in toothpastes, in candies and chewing gums. We report a case of a 50 year old woman, with persistent rhinitis, moderate asthma and nasal polyposis. She was a known, well controlled asthmatic patient. She presented to the emergency room with severe rhinorrhoea, sneezing, nasal obstruction, dyspnea and cough, after having a menthol-flavored candy. She experienced similar symptoms when she used a menthos and after brushing her teeth with toothpaste. Skin prick test with culprit toothpaste and menthol were negative. Because of her history, we speculate that the patient was aspirin-sensitive, so we performed an oral provocation test with aspirin in order to confirm the Aspirin-exacerbated respiratory disease diagnosis and it resulted positive at first dose. A challenge was then performed with menthol and another with toothpaste. The mechanism of the hypersensitivity reaction to aspirin is not immunological. Aspirin is known to cause inhibition of the cyclooxygenases, which metabolize arachidonic acid to prostaglandins. This inhibition leads to an up-regulation of the alternative pathway, with lipoxygenases metabolizing arachidonic acid to leukotrienes. The menthol, due to the same mechanism, might be considered one of the triggering of Aspirin-exacerbated respiratory disease.

Keywords : Menthol, aspirin, asthma