Use of intranasal ketorolac and modified oral aspirin challenge for desensitization of aspirin-exacerbated respiratory disease.
BACKGROUND
Intranasal ketorolac challenges can induce respiratory reactions in patients with aspirin-exacerbated respiratory disease (AERD).


OBJECTIVE
To determine whether intranasal ketorolac challenges might be used for aspirin desensitization.


METHODS
One hundred patients with suspected AERD who were referred to Scripps Clinic from May 1, 2007 to December 31, 2009 were challenged with 4 increasing doses of ketorolac intranasally at 30-minute intervals. Symptoms, objective changes in the results of their nasal examination, peak nasal inspiratory flow rates, and forced expiratory volume in 1 second (FEV(1)) values were recorded. After nasal ketorolac dosing, patients were given oral aspirin as part of the challenge and desensitization. A control group consisted of 100 patients who had previously undergone our standard oral aspirin challenges and desensitization. Both groups were consecutively enrolled and had similar clinical characteristics.


RESULTS
Compared with the standard oral aspirin challenge and desensitization, intranasal ketorolac and modified aspirin challenge significantly attenuated the mean percentage decrease in FEV(1) values (8.5% vs 13.4%; P = .01) and decreased the percentage of extrapulmonary reactions (23% vs 45%; P = .002), particularly laryngospasm (7% vs19%; P = .02) and gastrointestinal reactions (12% vs 33%; P = .001). This new protocol was significantly shorter, lasting an average of 1.9 vs 2.6 days (P = <.001). In fact, 83% of the patients completed the new protocol in less than 48 hours compared with only 20% in the oral challenge control group (P < .001).


CONCLUSIONS
Intranasal ketorolac challenge and desensitization followed by rapid oral aspirin challenges is effective, safe, and less time-consuming than our standard oral aspirin desensitization protocol.
Lee
Rachel U
RU
Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California 92130, USA.
White
Andrew A
AA
Ding
Ding
D
Dursun
Adile Berna
AB
Woessner
Katharine M
KM
Simon
Ronald A
RA
Stevenson
Donald D
DD
D000281:Administration, Intranasal; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D055963:Asthma, Aspirin-Induced / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D002985:Clinical Protocols; D003888:Desensitization, Immunologic; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests
D020911:Ketorolac Tromethamine; D001241:Aspirin