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


CONCLUSIONS
The severity of the historical aspirin/NSAID-induced asthma attack was not predictive of asthma severity during OAC.


CONCLUSIONS
These data provide further reassurance regarding the safety of outpatient aspirin desensitization.
Williams
Adam N
AN
Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, CA 92130, USA. a.williams33@yahoo.com .
Simon
Ronald A
RA
Woessner
Katharine M
KM
Stevenson
Donald D
DD
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D001249:Asthma / Q000139:chemically induced* / Q000503:physiopathology* / Q000628:therapy; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin