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Ann Allergy Asthma Immunol. 2016 Apr;116(4):321-328.e1. doi: 10.1016/j.anai.2015.12.026. Epub 2016 Jan 25.

Utility of low-dose oral aspirin challenges for diagnosis of aspirin-exacerbated respiratory disease.

Author information

  • 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York. Electronic address: Elina.Jerschow@einstein.yu.edu.
  • 2Jacobi Medical Center, Bronx, New York.
  • 3Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
  • 4Jagiellonian University Medical College, Krakow, Poland.
  • 5Ferkauf Graduate School of Psychology at Yeshiva University, Bronx, New York.

Abstract

BACKGROUND:

Aspirin-exacerbated respiratory disease (AERD) is diagnosed through graded aspirin challenges that induce hypersensitivity reactions and eicosanoid level changes. It is not known whether diagnostically useful changes also occur after low-dose aspirin challenges that do not induce hypersensitivity reactions.

OBJECTIVE:

To investigate the utility of low-dose oral aspirin challenges for diagnosing AERD by measuring different clinical parameters and eicosanoid changes.

METHODS:

Sixteen patients with AERD and 13 patients with aspirin-tolerant asthma underwent oral challenges with low-dose (20 or 40 mg) aspirin and diagnostic oral graded aspirin challenges (up to 325 mg of aspirin). Forced expiratory volume in 1 second, nasal peak flow, the fraction of exhaled nitric oxide (FeNO), and eicosanoid levels in plasma and urine were analyzed.

RESULTS:

In patients with AERD but not in those with aspirin-tolerant asthma, 40-mg aspirin challenges induced a significant mean (SEM) decrease from baseline in FeNO (19% [5.1%]; P = .001) without causing any hypersensitivity reaction. The FeNO decrease also occurred after higher-dose aspirin challenges (27.8% [4.9%]; P < .001). The sensitivity and specificity of 40-mg aspirin-induced FeNO changes for identifying AERD were 90% and 100% with an area under the curve of 0.98 (95% CI, 0.92-1.00). The low-dose challenge also induced a significant leukotriene E4 urine increase in patients with AERD (from 6.32 [0.08] to 6.91 [0.15] log-pg/mg creatinine; P < .001), but the sensitivity and specificity of these changes were less than for the FeNO changes.

CONCLUSION:

The low-dose aspirin-induced decrease in FeNO in patients with AERD may be useful for the diagnosis of aspirin allergy without inducing a hypersensitivity reaction.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT01320072.

PMID:
26822279
PMCID:
PMC4826295
[Available on 2017-04-01]
DOI:
10.1016/j.anai.2015.12.026
[PubMed - indexed for MEDLINE]
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