The value of aspirin challenge tests in the diagnosis of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease
10.3760/cma.j.cn115330-20230120-00035
- VernacularTitle:阿司匹林激发试验在诊断非甾体抗炎药加重呼吸道疾病中的价值
- Author:
Hao XIAO
1
;
Li ZHANG
;
Hang LIN
;
Yingli XIAO
;
Hongting ZHANG
;
Qiaoru JIA
;
Feng XU
;
Juan MENG
Author Information
1. 四川大学华西医院耳鼻咽喉头颈外科，成都 610041
- Keywords:
Aspirin challenge tests;
Non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD);
Chronic rhinosinusitis with nasal polyps (CRSwNP)
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2023;58(8):741-746
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the value of aspirin challenge tests in the diagnosis of non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (NERD).Methods:Fifty patients (22 males and 28 females; aged 16-61 years) who were diagnosed with chronic rhinosinusitis with nasal polyps (CRSwNP) with/without asthma, and underwent NERD standardized diagnosis in the Allergy Centre of West China Hospital, Sichuan University from December 2021 to November 2022 were included in the study. The first step was asking about the history of exacerbation respiratory symptoms after intake of any non-steroidal anti-inflammatory drug, including aspirin; the second step was performing intranasal aspirin challenge (IAC); and the third step was performing oral aspirin challenge (OAC). The diagnosis of NERD was made if any of the above steps was positive, and the subsequent steps were not performed, otherwise the diagnosis was made to OAC. If OAC was negative, the diagnosis was non-NERD. All patients completed the sino-nasal outcome test 22 (SNOT 22) score, Lund-Kennedy score by nasal endoscopic, allergen skin prick test, blood routine and serum total IgE test. SPSS version 20.0 was used for statistical analysis.Results:The diagnosis of NRED was confirmed in 27 patients (27/50, 54%). Seven (7/50, 14%) of them were diagnosed by clinical history and 20 (20/50, 40%) were diagnosed by aspirin challenge tests, of which 17 (17/20, 85%) were positive to IAC and 3 (3/20, 15%) to OAC. Of the 43 patients who underwent IAC testing, only 2 (2/43, 5%) developed asthma attacks during challenge. Comparing the clinical characteristics of patients in NERD and non-NERD group, there were significant differences between the two groups in gender ( P=0.001), hyposmia ( P=0.003), history of repeated CRSwNP surgeries ( P=0.028), comorbid asthma ( P=0.013), SNOT-22 score ( P=0.004) and the percentage of peripheral blood eosinophil ( P=0.043). Conclusions:Patients may be underdiagnosed if the diagnosis of NERD is made only by medical history, and it is necessary to carry out aspirin challenge tests. IAC is an important means to diagnose NERD with high accuracy and good safety. However, If IAC is negative, further OAC is required.
