Predicting outcomes of oral aspirin challengesin patients with asthma, nasal polyps, andchronic sinusitis

Division of Allergy, Asthma and Immunology, Scripps Health Graduate Education Department, Ataturk Chest Diseases and Thoracic Surgery, Training and Research Hospital, Ankara, Turkey.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology (Impact Factor: 2.6). 06/2008; 100(5):420-5. DOI: 10.1016/S1081-1206(10)60465-6
Source: PubMed


A definitive diagnosis of aspirin-exacerbated respiratory disease (AERD) requires a positive oral aspirin challenge (OAC), but predicting which patients will have positive challenges is often difficult.
To analyze information about historical aspirin- and nonsteroidal anti-inflammatory drug (NSAID)-associated respiratory reactions and clinical characteristics as potential markers to predict positive OACs.
A total of 243 patients underwent OACs. Data related to previous reactions and clinical characteristics of patients were correlated with the result of the OACs.
Without prior exposure to aspirin or NSAIDs, the chance of a positive OAC was 5 in 12 (42%) but was 198 in 231 (86%) for those with a history of aspirin- and NSAID-associated asthma attacks. Sex, atopy, number of sinus infections per year, and number of sinus surgical procedures were not associated with positive OACs. Patients with 2 or more prior aspirin- and NSAID-associated respiratory reactions had an 89% chance of having a positive OAC vs single reactors (80%; P = .04). Mild or moderate prior reactions were associated with 84% or 80% positive OACs, whereas 100% of the 45 patients with severe prior reactions had positive OACs (P = .007). Except for hospitalizations, treatment locations of prior reactions (home or emergency department) did not seem to make any difference. Logistic regression identified age, sense of smell, and multiple prior reactions as independent risk factors associated with positive OACs.
Age younger than 40 years, poor sense of smell, multiple prior respiratory reactions, and severe prior asthmatic reactions associated with aspirin and NSAIDs significantly increased the chances of a positive OAC.

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    • "Total IgE was measured with the CAP system (Phadia, Uppsala, Sweden), and atopy was defined as having a wheal reaction equal to or greater than the histamine or 3 mm in diameter. An oral aspirin challenge (OAC) was performed with increasing doses,12 based on the updated practice parameter (2010) of the American College of Allergy, Asthma & Immunology/American Academy of Allergy, Asthma & immunology.13,14 Briefly, patients with a history of aspirin hypersensitivity were given 30 mg orally. "
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    ABSTRACT: Endoplasmic reticulum (ER) stress has recently been observed to activate NF-kappaB and induce inflammatory responses such as asthma. Activating transcription factor 6β (ATF6B) is known to regulate ATFα-mediated ER stress response. The aim of this study is to investigate the associations of ATF6B genetic variants with aspirin-exacerbated respiratory disease (AERD) and its major phenotype, % decline of FEV1 by aspirin provocation. Four common single nucleotide polymorphisms (SNPs) of ATF6B were genotyped and statistically analyzed in 93 AERD patients and 96 aspirin-tolerant asthma (ATA) as controls. Logistic analysis revealed that 2 SNPs (rs2228628 and rs8111, P=0.008; corrected P=0.03) and 1 haplotype (ATF6B-ht4, P=0.005; corrected P=0.02) were significantly associated with % decline of FEV1 by aspirin provocation, whereas ATF6B polymorphisms and haplotypes were not associated with the risk of AERD. Although further functional and replication studies are needed, our preliminary findings suggest that ATF6B may be related to obstructive phenotypes in response to aspirin exposure in adult asthmatics.
    Allergy, asthma & immunology research 03/2014; 6(2):142-8. DOI:10.4168/aair.2014.6.2.142 · 2.43 Impact Factor
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    • "Indeed, in our pioneer work [6] involving 1372 DPTs performed using various drugs, including ß-lactams (30.3%), aspirin (14.5%), other NSAIDs (11.7%), paracetamol (8.9%), macrolides (7.4%), and quinolones (2.4%), there were only 241 (17.6%) positive results. While being a diagnostic tool, confirming the role of NSAIDs in 13.4% [14] to 85.7% [15] of the suspicions, DPT holds an intrinsic scientific value, since it generates precious knowledge. In this respect, we [16] used data collected from a large database in 980 patients gathered over a 10-year period (using both the clinical history and the results of the DPTs) to put forward a new classification of NSAIDs DHR. "
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    ABSTRACT: Drug provocation tests (DPTs) are often needed when evaluating patients with suspected drug hypersensitivity reactions. General considerations on DPTs, with regard to indications, contraindications, methods, limitations and interpretations have been thoroughly addressed and various protocols are published. However, the field of drug allergy is changing and DPTs make no exception. Novel (or sometimes, simply renewed) approaches arise, awaiting to be either validated or refuted in larger studies in the future. Instead of covering the whole topic of DPTs, this paper will address these recent and challenging aspects.
    Allergy Asthma and Clinical Immunology 04/2013; 9(1):12. DOI:10.1186/1710-1492-9-12 · 2.03 Impact Factor
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    • "However, 16% of patients who believed they had AERD, based upon a historical asthma attack after ingesting aspirin/NSAID, underwent negative oral aspirin challenges and therefore, did not meet criteria for AERD.18 On the other hand, in that same study, of patients who had nasal polyps, chronic sinusitis, asthma and were avoiding aspirin and NSAIDs, only 43% had positive oral aspirin challenges.18 Thus, AERD is both over diagnosed (coincidental history) or under diagnosed (no prior exposure to aspirin or COX-1 inhibitor during the time of the inflammatory respiratory disease). "
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    ABSTRACT: The clinical syndrome of aspirin-exacerbated respiratory disease (AERD) is a condition where inhibition of cyclooxygenase-1 (COX-1) induces attacks of upper and lower airway reactions, including rhinorrhea and varying degrees of bronchospasm and laryngospasm. Although the reaction is not IgE-mediated, patients can also present with anaphylactic hypersensitivity reactions, including hypotension, after exposure to COX-1 inhibiting drugs. All patients with AERD have underlying nasal polyps and intractable sinus disease which may be difficult to treat with standard medical and surgical interventions. This review article focuses on the management of AERD patients with a particular emphasis on aspirin desensitization and continuous treatment with aspirin.
    Allergy, asthma & immunology research 01/2011; 3(1):3-10. DOI:10.4168/aair.2011.3.1.3 · 2.43 Impact Factor
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