Nasal Ketorolac Challenge Using Acoustic Rhinometry in Patients With Aspirin-Exacerbated Respiratory Disease

Abstract

Background: Safer and less time-consuming alternatives to single-blind placebo-controlled oral challenge (SBPCOC) have been sought for the diagnosis of aspirin-exacerbated respiratory disease (AERD). Nasal challenges with various nonsteroidal anti-inflammatory drugs and assessment methods have been developed. Objective: Our objective was to evaluate the utility and safety of nasal ketorolac challenge (NKC) using acoustic rhinometry in patients with suspected AERD. Methods: The study population comprised 36 patients with suspected AERD. NKC was performed with placebo (saline) and 13 mg of ketorolac sprayed as aerosol into both nostrils. A positive challenge result was defined as an increase of ≥30% in nasal symptoms (recorded using a visual analog scale) and a 30% drop in the sum of the volumes of both nasal cavities at 2-8 cm. Patients with a negative NKC result underwent SBPCOC with aspirin (cumulative dose of 750 mg). Results: A naso-ocular reaction during NKC was detected in 21 patients. Four patients also developed mild asthma exacerbations (although only 1 experienced a decrease in FEV 1 >15%). No other significant adverse events occurred. The remaining 15 patients with a negative NKC result had a negative response during aspirin SBPCOC. Conclusion: NKC assessed using acoustic rhinometry is a reliable method for the study of patients with AERD. We suggest that NKC assessed with acoustic rhinometry was useful and safe for selection of candidates for safe oral aspirin challenge.

Statement of the Spanish Society of Allergology and Clinical Immunology on Provocation Tests With Aspirin/Nonsteroidal Anti-inflammatory Drugs

“…Lysine-aspirin is not available in the USA, where nasal provocation is performed using intranasal ketorolac [33,91]. Experience with ketorolac has been reported by Quiralte-Castillo et al [92].…”

Perspective: the nose and the stomach play a critical role in the NZACE2-Pātari* (modified ACE2) drug treatment project of SARS-CoV-2 infection

“…Administration of drugs to the nose such as erythropoietin or glucagon did not cause serious adverse reactions [ 43 , 44 ]. Similarly, nasal ketorolac challenges in highly sensitized Samter’s triad patients rarely caused bronchospasm [ 45 ].…”

Nasal lysine aspirin challenge

“…Brak jednoznacznego punktu odcięcia uzasadnia konieczność wykonania dodatkowo badań czynnościowych. [5]. Gdy zastosowano próg odcięcia 25% zmniejszenia objętości w rynometrii akustycznej, swoistość próby wynosiła 94%, a czułość 73%.…”