EAACI/GA2LEN guideline: aspirin provocation tests for diagnosis of aspirin hypersensitivity

Abstract

Aspirin and other nonsteroidal anti‐inflammatory drugs (NSAIDs) are among the most common causes of adverse drug reactions. Majority of them are of the hypersensitivity type. The two frequent clinical presentations of aspirin hypersensitivity are: aspirin‐induced bronchial asthma/rhinosinusitis (AIA/R) and aspirin‐induced urticaria/angioedema (AIU). The decisive diagnosis is based on provocation tests with aspirin, as the in vitro test does not hold diagnostic value as yet. Detailed protocols of oral, bronchial and nasal aspirin provocation tests are presented. Indications, contraindications for the tests, the rules of drug withdrawal and equipment are reviewed. Patient supervision and interpretations of the tests are proposed.

Association analysis of formyl peptide receptor 2 (FPR2) polymorphisms and Aspirin exacerbated respiratory diseases

“…Oral aspirin challenge was performed with increasing doses of aspirin using methods slightly modified from those described previously. 2,19 Briefly, the patient having history of aspirin hypersensitivity was given 30 mg and those having no history started 100 mg of aspirin orally. Respiratory and naso-ocular symptoms, blood pressure, external signs (urticaria and angio-oedema) and FEV 1 were documented every 30 min for a period of 1.5 h. In the absence of any symptoms or signs suggestive of adverse reaction, 60 mg or 100 mg of aspirin was administered and the same measurements were repeated every 1 h, with a final dose of 450 mg or until the patient developed a reaction.…”

Current management of aspirin‐exacerbated respiratory disease

“…4 Although sensitivity of oral, inhalation and nasal aspirin challenges are similar, oral 28 Prescriber July 2012 www.prescriber.co.uk challenge is considered to be the gold standard in confirming NSAID hypersensitivity. Oral and inhalation challenges should be performed under the supervision of a physician skilled in performing provocation tests, with resuscitation immediately available.…”

Genetic association analysis of TAP1 and TAP2 polymorphisms with aspirin exacerbated respiratory disease and its FEV1 decline

“…Oral aspirin challenge was performed with a slight modification in increasing doses of aspirin, 11 following the guidelines of EAACI/GA2LEN. 12 Changes in FEV1 were followed for 5 h after the last aspirin challenge dose. Aspirin-induced bronchospasms, as reflected by rate (%) of FEV1 decline, were calculated as the pre-challenge FEV1 minus the post-challenge FEV1 divided by the prechallenge FEV1.…”