Aspirin challenge tests

From the first study in patients with local IgE against SEs [10] it appeared that the highest IgE concentrations were obtained from samples of aspirin-sensitive subjects. We therefore extended our observations in a nonallergic, but severely inflamed subgroup of patients, who also suffered from asthma. Subjects with nasal polyposis from Poland were classified as aspirin-sensitive (ASNP) or aspirin-tolerant (ATNP) asthmatics, based on a bronchial aspirin challenge test [47], Homogenates prepared from NP tissue were analyzed for concentrations of eosinophilic markers, total IgE and IgE antibodies to enterotoxins (SEA, SEC, TSST-1) [22], and compared to inferior nasal turbinates from healthy subjects. 

Aspirin hypersensitivity is relatively common in adults (about 20%). Estimates of the prevalence of aspirin-induced asthma vary from 3.3 to 44% in different reports (SEDA-5,169), although it is often only demonstrable by challenge tests with spirometry, and only 4% have problems in practice. Patients with existing asthma and nasal polyps or chronic urticaria have a greater frequency of hypersensitivity (76), and women appear to be more susceptible than men, perhaps particularly during the childbearing period of life (77). Acute intolerance to aspirin can develop even in patients who have taken the drug for some years without problems. 

A 40-year-old woman with no personal or family history of asthma had dyspnea, wheezing, and nasal symptoms for 2 years whenever she used toothpaste and/or ingested mint confections. She had no history of aspirin sensitivity, and a challenge test with a menthol solution diluted in alcohol ruled out any possibihty that the asthma had been caused by preservatives, dyes, or other additives. 

Kurek M, Grubska-Suchanek E. Challenge tests with food additives and aspirin in the diagnosis of chronic urticaria. J Allergy Clin Immunol 2001 41 463-9. 

Aspirin intolerance has been described in a few families (Starr 1971 Lockey et al. 1973 Von Maur et al. 1974 Delaney 1973). A family aggregation, however, appears to be very rare (Falliers 1974). In our population of 500 patients with proven AIA, we found only two cases of familial intolerance to aspirin. One was a 19-year-old male, whose only brother, also asthmatic, as known to have died after taking aspirin. The other was a 21-year-old asthmatic female, whose father had never suffered from asthma but gave a history of angioedema and urticaria without dyspnea following aspirin ingestion this was confirmed in a challenge test. 

An interesting modification of the challenge tests was developed by Bianco and his colleagues (Bianco et al. 1977 Pasargiklian et al. 1977). In this method, instead of giving aspirin by mouth, an aerosol of lysine acetylsalicylate is administered by inhalation. 

The in vitro platelet factor 3 immunoinjury test for antiplatelet antibody (Kar-PATKIN 1971) might be of diagnostic help in some cases. The most reliable method for confirmation of the diagnosis is in vivo challenge with a small amount of aspirin. This test entails a risk to the patients and should not be attempted, when any one of the in vitro tests is positive (Garg and Sarker 1974). 

Von Maur K, Adkinson NF, Van Metre TE, Marsh DG, Norman PS (1974) Aspirin intolerance in a family. J Allergy Clin Immunol 54 380-395 Warin RP (1960) The effect of aspirin in chronic urticaria. Br J Dermatol 72 350-351 Warin RP, Smith RJ (1976) Challenge test battery in chronic urticaria. Br J Dermatol 94 401 06... 

Challenge testing is the only sure way to diagnose or exclude true sensitivity to an NSAID. Oral challenge with drug and placebo is usually undertaken over a 2 day period. A maximum dose of 325 mg or 5(X) mg aspirin is often used. Other diagnostic methods sometimes employed include BAT (often of doubtful value) and measurement of released cysteinyl leukotrienes and 15-HETE. 

The accurate diagnosis of AIA can be established by oral, inhaled, nasal or intravenous placebo-controlled provocations tests with increasing doses of aspirin [10], There is no reliable in vitro test. Oral challenges are most commonly performed, because the oral route mimics natural exposure and the test does not require special equipment, except simple spirometry. The threshold dose of aspirin which provokes a 20% fall in FEVi (positive reaction) will vary with individual patients, depending... 

This ruggedness test provided a greater challenge to the method than did the test conditions of the aspirin studies, most factors being tested to larger extreme values. 

The hypothesis that in aspirin-induced asthma the attacks are triggered by inhibition of COX-1 and not COX-2 has been tested in three small studies, two of which were double-blind and placebo-controlled (66-68). In the first stndy (66) 12 patients with aspirin-induced asthma were challenged with increasing doses of rofe-coxib (1.25-25 mg/day for 5 days) no patients had any adverse symptoms, and biochemical markers that reflect intolerance to aspirin in asthma (nrinary lenkotriene E4 and 9a-lip-PGF-2) were nnchanged. 

Thune P, Granholt A (1975) Provocation tests with antiphlogistic and food additives in recurrent urticaria. Dermatologica 151 360-367 Trautlein JJ, Mann WJ (1978) Anaphylactic shock caused by yellow dye (FD C No. 5 and FD C No. 6) in an enema (case report). Ann Allergy 41 28-29 Vedanthan PK, Menon MM, Bell TD, Bergin D (1977) Aspirin and tartrazine oral challenge incidence of adverse response in chronic childhood asthma. J Allergy Clin Immunol 60 8-13... 

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