Nasal provocation test (NPT) with aspirin: a sensitive and safe method to diagnose aspirin‐induced asthma (AIA)

Alonso‐Llamazares, Ana; Martínez-Cócera, C.; Domínguez‐Ortega, Javier; Robledo-Echarren, T.; M, Cimarra-Alvarez; Castillo, M. Mesa del

doi:10.1034/j.1398-9995.2002.t01-1-13447.x

Cited by 57 publications

(31 citation statements)

References 21 publications

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“…Milewski et al (30) and Alonso-Llamazares et al (32) found that the specificity of nasal challenge with lysineaspirin reached 95.7% and 92.5% respectively, whereas its sensitivity was 86.7% and 80%, respectively. The predictive value of a negative result of l-ASA nasal challenge was 78.6% and 89.2%, respectively (30,32).…”

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confidence: 99%

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EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivity

Niżankowska‐Mogilnicka

Bochenek

Mastalerz

et al. 2007

Allergy

361

327

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Aspirin and other nonsteroidal anti‐inflammatory drugs (NSAIDs) are among the most common causes of adverse drug reactions. Majority of them are of the hypersensitivity type. The two frequent clinical presentations of aspirin hypersensitivity are: aspirin‐induced bronchial asthma/rhinosinusitis (AIA/R) and aspirin‐induced urticaria/angioedema (AIU). The decisive diagnosis is based on provocation tests with aspirin, as the in vitro test does not hold diagnostic value as yet. Detailed protocols of oral, bronchial and nasal aspirin provocation tests are presented. Indications, contraindications for the tests, the rules of drug withdrawal and equipment are reviewed. Patient supervision and interpretations of the tests are proposed.

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confidence: 99%

“…The predictive value of a negative result of l-ASA nasal challenge was 78.6% and 89.2%, respectively (30,32). Subjects should give written informed consent to participate in aspirin challenges after the actual nature of the procedures has been thoroughly explained to them by the attending physician.…”

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confidence: 99%

EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivity

Niżankowska‐Mogilnicka

Bochenek

Mastalerz

et al. 2007

Allergy

361

327

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“…Recently, Miller at al [10] also reported a high percentage of positive challenge results (45%) with 325 mg of aspirin in patients who had previously experienced a negative acoR-monitored nasal challenge with aspirin-lysine [10]. Anterior active rhinomanometry used as an objective assessment method revealed that only 16 of 20 patients with oral challenge-proven AERD (80%) had a positive nasal response to the nasal challenge with aspirinlysine [11]. These different clinical outcomes suggest that the NSAID, the objective method used to measure the changes in nasal airways, or both might have a relevant effect on the results of nasal NSAID challenges.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, alternative methods have been developed to enhance safety and reduce the time needed for testing. Bronchial challenges [7] and nasal challenges [8][9][10][11][12] have been developed with various NSAIDs and assessment methods. Lee et al [8] recently presented a novel method using nasal ketorolac as the challenge drug and assessing the nasal response with a peak nasal inspiratory flow (PNIF) meter.…”

Section: Introductionmentioning

confidence: 99%

Nasal Ketorolac Challenge Using Acoustic Rhinometry in Patients With Aspirin-Exacerbated Respiratory Disease

Quiralte-Castillo

Ávila-Castellano

Cimbollek

et al. 2017

J Investig Allergol Clin Immunol

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Background: Safer and less time-consuming alternatives to single-blind placebo-controlled oral challenge (SBPCOC) have been sought for the diagnosis of aspirin-exacerbated respiratory disease (AERD). Nasal challenges with various nonsteroidal anti-inflammatory drugs and assessment methods have been developed. Objective: Our objective was to evaluate the utility and safety of nasal ketorolac challenge (NKC) using acoustic rhinometry in patients with suspected AERD. Methods: The study population comprised 36 patients with suspected AERD. NKC was performed with placebo (saline) and 13 mg of ketorolac sprayed as aerosol into both nostrils. A positive challenge result was defined as an increase of ≥30% in nasal symptoms (recorded using a visual analog scale) and a 30% drop in the sum of the volumes of both nasal cavities at 2-8 cm. Patients with a negative NKC result underwent SBPCOC with aspirin (cumulative dose of 750 mg). Results: A naso-ocular reaction during NKC was detected in 21 patients. Four patients also developed mild asthma exacerbations (although only 1 experienced a decrease in FEV 1 >15%). No other significant adverse events occurred. The remaining 15 patients with a negative NKC result had a negative response during aspirin SBPCOC. Conclusion: NKC assessed using acoustic rhinometry is a reliable method for the study of patients with AERD. We suggest that NKC assessed with acoustic rhinometry was useful and safe for selection of candidates for safe oral aspirin challenge.

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“…Our results contrast with those of Pawlowicz et al [33], who observed a significant fall in FEV 1 in all the patients they evaluated. Most authors have reported only a few mild reactions, however, thus demonstrating the high safety profile of the nasal challenge test with l -ASA [7,8,10,16,34]. …”

Section: Discussionmentioning

confidence: 99%

Acoustic Rhinometry and Aspirin Nasal Challenge in the Diagnosis of Aspirin-Intolerant Asthma: Clinical Finding and Safety Aspects

Muñoz-Cano¹,

Bartra²,

Sánchez-López

et al. 2012

Int Arch Allergy Immunol

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Background: The safety and utility of nasal provocation tests with lysine-aspirin (l-ASA) in the diagnosis of aspirin-intolerant asthma (AIA) have previously been described in a short series of patients. Objectives: To describe the clinical features and safety of an l-ASA challenge test in patients with AIA. Methods: We evaluated 72 patients (79% women), with a mean ± SD age of 47.9 ± 14.5 years. All patients were submitted to an l-ASA nasal provocation test (29 mg in each nostril) under acoustic rhinometry (AcR) control. Symptom score (0–3), visual analogical scale and nitric oxide determinations were performed at baseline and at 15, 30, 60 and 90 min. A decrease in nasal volume of at least 25% was considered a positive test. Nasal nitric oxide (nNO) and forced expiratory volume in 1 s were measured. Results: Nasal congestion and rhinorrhea represented 51 and 32%, respectively, of total symptoms. According to AcR data, the l-ASA challenge test was positive in 20% of patients at 15 min, an additional 36% were positive at 30 min, 18% at 60 min, and the remaining 26% at 90 min. nNO nasal values decreased but did not reach statistical significance. No pulmonary or systemic reactions were observed. Conclusions: Symptoms of nasal congestion associated with the reduction in nasal volume measured by AcR are the most useful parameters for establishing the diagnosis of AIA using the l-ASA nasal challenge. The method is very well tolerated and can be safely used even in patients with severe asthma.

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Nasal provocation test (NPT) with aspirin: a sensitive and safe method to diagnose aspirin‐induced asthma (AIA)

Abstract: NPT has a high sensitivity and specificity in the diagnosis of AIA. An oral provocation should be performed to confirm the result whenever the clinical situation of the patient permits it.

Cited by 57 publications

References 21 publications

EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivity

EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivity

Nasal Ketorolac Challenge Using Acoustic Rhinometry in Patients With Aspirin-Exacerbated Respiratory Disease

Acoustic Rhinometry and Aspirin Nasal Challenge in the Diagnosis of Aspirin-Intolerant Asthma: Clinical Finding and Safety Aspects

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