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Leukotriene-Associated Rash in Aspirin-Exacerbated Respiratory Disease

About 20% of patients with AERD develop a characteristic itchy rash during their aspirin/NSAID-induced reactions, in addition to their respiratory symptoms. We found that 14% of the 387 patients with AERD queried at the Brigham and Women’s Hospital since 2013 report occurrence of a similar rash even when they are completely avoiding all aspirin and NSAIDs. As with the NSAID-induced rash, our patients describe a red, itchy, mostly flat rash, most notable on the arms and legs, including the palms and bottoms of the feet, that tends to spare the abdomen and back. We have observed that oral antihistamines are not generally helpful, but many patients, as in the two cases described in this publication, report that zileuton, a 5-lipoxygenase inhibitor, and dupilumab, an antibody that blocks IL-4Ra, are efficacious treatments for the rash.

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