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

Abstract

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 FEV(1) 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 FEV(1) 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 FEV(1) 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 FEV(1) 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.

• Authors: Adam N Williams, Ronald A Simon, Katharine M Woessner, Donald D Stevenson
• Journal: The Journal of allergy and clinical immunology (J Allergy Clin Immunol) Vol. 120 Issue 2 Pg. 273-7 (Aug 2007) ISSN: 0091-6749 [Print] United States
• PMID: 17481713 (Publication Type: Journal Article)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Aspirin

Topics

• Adult
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects)
• Aspirin (administration & dosage, adverse effects)
• Asthma (chemically induced, physiopathology, therapy)
• Cohort Studies
• Dose-Response Relationship, Drug
• Female
• Forced Expiratory Volume
• Hospitalization
• Humans
• Male
• Medical Records
• Middle Aged
• Predictive Value of Tests
• Severity of Illness Index