The relationship between historical aspirin-induced asthma and severity of asthma induced during oral aspirin challenges

Background

Historical aspirin- or nonsteroidal anti-inflammatory drug (NSAID)–induced reactions might provide predictive information about the severity of reactions in patients with aspirin-exacerbated respiratory disease (AERD) undergoing oral aspirin challenge (OAC).

Objective

We sought to assess the relationship between historical aspirin- or NSAID-induced bronchial reactions and the severity of bronchial reactions during OAC in patients with AERD.

Methods

Data regarding the provoking doses, treatments, and treatment settings of historical aspirin/NSAID-induced reactions were recorded, analyzed, and compared with the provoking doses, maintenance regimens, and observed decreases in FEV₁ that occurred during OAC in 210 consecutive patients referred with suspected AERD.

Results

Of 147 patients who reported seeking acute medical care for their historical aspirin/NSAID-induced asthma attacks, 101 (69%) were treated in an emergency department and released, and 46 (31%) required hospitalization. During OAC in these 147 subjects, 23 (16%) had a 20% to 29% decrease and 14 (10%) had a 30% or greater decrease in FEV₁ values from baseline. Of the 46 patients previously hospitalized for aspirin/NSAID-induced asthma attacks, 9 (20%) had a 20% to 29% decrease and 6 (13%) had a 30% or greater decrease in FEV₁ during OAC. By contrast, of the 63 patients who treated their prior aspirin/NSAID-induced reactions at home, 5 (8%) had a 20% to 29% decrease and 5 (8%) had a 30% or greater decrease in FEV₁ during OAC (P = not significant for both).

Conclusion

The severity of the historical aspirin/NSAID-induced asthma attack was not predictive of asthma severity during OAC.

Clinical implications

These data provide further reassurance regarding the safety of outpatient aspirin desensitization.

Key words: Aspirin, nonsteroidal anti-inflammatory drugs, leukotrienes, leukotriene modifier drugs, asthma, aspirin-exacerbated respiratory disease, aspirin challenge, aspirin desensitization, nasal polyposis, chronic rhinosinusitis

Abbreviations used: AERD, Aspirin-exacerbated respiratory disease, ED, Emergency department, ICU, Intensive care unit, LTMD, Leukotriene modifier drug, NSAID, Nonsteroidal anti-inflammatory drug, OAC, Oral aspirin challenge