Use of intranasal ketorolac and modified oral aspirin challenge for desensitization of aspirin-exacerbated respiratory disease

Lee, Rachel U.; White, Andrew A.; Ding, Ding; Dursun, Adile Berna; Woessner, Katharine M.; Simon, Ronald A.; Stevenson, Donald D.

doi:10.1016/j.anai.2010.05.020

Cited by 109 publications

(81 citation statements)

References 12 publications

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“…However, in a recent study, up to 10% of patients with a negative NKC result experienced respiratory reactions during a subsequent oral aspirin challenge. The authors evaluated 100 patients with AERD (by clinical history and positive oral aspirin challenge) who were rechallenged with intranasal ketorolac [8]. A positive reaction (defined as rhinitis, conjunctivitis, and/or bronchospasm with a significant decrease in the PNIF rate and/or FEV 1 values) was observed in 90%.…”

Section: Discussionmentioning

confidence: 99%

“…All patients were included in a previously established NKC whose diagnostic safety and accuracy were assessed using acoR (A1-Compact, Optomic) [8,13] at least 1 month after resolution of the NSAID-induced respiratory reaction. Each patient assessed nasal blockage, rhinorrhea, itching, and sneezing before and after nasal challenge using a 100-mm visual analog scale (VAS) with a total range of 0 to 400 mm.…”

Section: Nasal Ketorolac Challengementioning

confidence: 99%

“…Bronchial challenges [7] and nasal challenges [8][9][10][11][12] have been developed with various NSAIDs and assessment methods. Lee et al [8] recently presented a novel method using nasal ketorolac as the challenge drug and assessing the nasal response with a peak nasal inspiratory flow (PNIF) meter. Nasal challenge provided a rapid and safe means of confirming the diagnosis when it induced local reactions in the nasal airway of AERD patients and thus obviated the need for additional SBPCOC.…”

Section: Introductionmentioning

confidence: 99%

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

Quiralte-Castillo

Ávila-Castellano

Cimbollek

et al. 2017

J Investig Allergol Clin Immunol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Nasal Ketorolac Challengementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Quiralte-Castillo

Ávila-Castellano

Cimbollek

et al. 2017

J Investig Allergol Clin Immunol

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“…There are not desensitization schemes in the literature for ibuprofen, but the analogy of metabolic drug effect cox 1 inhibitor is known [3] for all unrelated NSAIDs and equivalent pharmacological power, as well as the possibility, in the literature verified with ketorolac [4], of switching between 1 drug and the other in the process of desensitization Many data exist on aspirin desensitization on NSAIDs exacerbated respiratory diseases [5][6][7][8][9][10][11][12], particularly in asthma and rhinosinusitis, and NIUA [13]. Aspirin desensitization is also indicated in patients who need chronic antiplatelet treatment with aspirin for artery coronary disease [14][15][16][17][18][19][20][21][22][23][24][25] or chronic anti-inflammatory treatment with NSAIDs.…”

Section: Discussionmentioning

confidence: 99%

Effective Ibuprofen Desensitization in a Patient with Myopericarditis

Cortellini¹,

Lippolis²,

Amati³

et al. 2018

Pharmacology

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To date, aspirin desensitization is employed with patients with nonsteroidal anti-inﬂammatory drugs (NSAIDs) exacerbated respiratory diseases (NERD) or with aspirin or NSAIDs hypersensitive patients needing a stent procedure for coronary artery disease. On the other hand, few data exist regarding aspirin desensitization in other cardiological features and particularly we haven’t data on different NSAIDs desensitization. Only for NERD patients we have data on ketorolac use. We report an efficacious desensitization procedure for ibuprofen in urticaria/angioedema patient with pericarditis and myocarditis associated.

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“…58 The experimental group of patients underwent a modified desensitization that included ketorolac and aspirin, and they were compared with a control group who underwent oral aspirin challenge only. Of the 100 subjects enrolled, 82 had a positive challenge result and met the diagnostic criteria for AERD.…”

Section: Ketorolac (Toradol) Desensitizationmentioning

confidence: 99%