Effect of leukotriene modifier drugs on the safety of oral aspirin challenges.
BACKGROUND
Aspirin-exacerbated respiratory disease can be diagnosed with oral aspirin challenges and treated with aspirin desensitization.


OBJECTIVE
To evaluate whether controller medications, particularly leukotriene modifier drugs, taken during oral aspirin challenges can reduce the risk of severe asthmatic responses.


METHODS
The medical records of 676 patients who had undergone oral aspirin challenges, followed by aspirin desensitization, were reviewed. Asthmatic responses were stratified based on severity of bronchospastic response or lack of response. The effect of pretreatment with controller medications on the outcome of oral aspirin challenges was measured.


RESULTS
Leukotriene modifier drugs had the most significant effect in protecting the lower airways from severe reactions (P = .004). The protective effect of leukotriene modifier drugs was observed in patients already taking systemic corticosteroids, where the addition of leukotriene modifier drugs significantly shifted the response toward a milder asthmatic response (P < .001).


CONCLUSIONS
Protection from significant aspirin-induced bronchospasm during oral aspirin challenge can be accomplished with leukotriene modifier drugs. The use of a combination of inhaled corticosteroids, long-acting beta-agonists, systemic corticosteroids, and leukotriene modifier drugs stabilized underlying airways in preparation for a reasonably safe and accurate oral aspirin challenge. However, only pretreatment with leukotriene modifier drugs enhanced the safety of oral aspirin challenge in patients with aspirin-exacerbated respiratory disease by significantly decreasing the degree of asthmatic responses. Therefore, outpatient oral aspirin challenges in most well-selected patients appear to be a reasonable decision.
White
Andrew
A
Department of Allergy and Immunology, Naval Medical Center San Diego, San Diego, California 92106, USA. drew_white@hotmail.com
Ludington
Elizabeth
E
Mehra
Purvi
P
Stevenson
Donald D
DD
Simon
Ronald A
RA
D000085:Acetates / Q000627:therapeutic use; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D001249:Asthma / Q000139:chemically induced / Q000276:immunology / Q000517:prevention & control; D003521:Cyclopropanes; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D006918:Hydroxyurea / Q000031:analogs & derivatives / Q000627:therapeutic use; D007211:Indoles; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D016859:Lipoxygenase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D048448:Phenylcarbamates; D011804:Quinolines / Q000627:therapeutic use; D013440:Sulfides; D013449:Sulfonamides; D014105:Tosyl Compounds / Q000627:therapeutic use; D016896:Treatment Outcome
D000085:Acetates; D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D007211:Indoles; D020024:Leukotriene Antagonists; D016859:Lipoxygenase Inhibitors; D048448:Phenylcarbamates; D011804:Quinolines; D013440:Sulfides; D013449:Sulfonamides; D014105:Tosyl Compounds; C093875:montelukast; D001241:Aspirin; C063449:zileuton; D006918:Hydroxyurea; C062735:zafirlukast