title: The values of nasal provocation test and basophil activation test in the different patterns of ASA/NSAID hypersensitivity.
abstract: BACKGROUND
  The oral provocation test (OPT) is the current gold standard to diagnose aspirin hypersensitivity syndrome although it is time-consuming and contains some systemic risks. Other reliable methods with lower side effects and shorter test duration are being investigated.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the efficacy of the nasal provocation test (NPT) and the basophil activation test (BAT) in the diagnosis of different subtypes of aspirin sensitivity.
  
  
  METHODS
  Thirty aspirin sensitivity patients with cutaneous and respiratory manifestations underwent NPT and BAT with lysine-ASA. NPT result was interpreted as recommended in EAACI/GA2LEN guidelines and receiver operating characteristic analysis of BAT was performed by using 15 NSAIDs tolerant volunteers as a control group.
  
  
  RESULTS
  NPT was positive in 60% (18/30) of patients and BAT was positive in 76.7% (23/30) of patients. The incubation of basophils with 0.31 mg/ml of lysine-aspirin and using 4.6% activated basophils gives the best predictive values to diagnose aspirin sensitivity. The combination of both tests yielded positive results in 80% and 93.3% of aspirin-induced cutaneous and respiratory patterns. The agreement between NPT and BAT results was 63.3%.
  
  
  CONCLUSIONS
  NPT and BAT are beneficial to detect patients with aspirin sensitivity. The combination of both tests have additional diagnostic values; less time-consuming than OPT and their complications are negligible. A reliable alternative method with minimum side effects is needed to diagnose aspirin sensitivity in suspected patients who have contraindications for OPT.
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Wismol
authors.forename: P
authors.initials: P
authors.lastname: Putivoranat
authors.forename: S
authors.initials: S
authors.lastname: Buranapraditkun
authors.forename: P
authors.initials: P
authors.lastname: Pinnobphun
authors.forename: K
authors.initials: K
authors.lastname: Ruxrungtham
authors.forename: J
authors.initials: J
authors.lastname: Klaewsongkram
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000276:immunology; D001241:Aspirin / Q000009:adverse effects / Q000276:immunology; D055963:Asthma, Aspirin-Induced / Q000175:diagnosis*; D015549:Basophil Degranulation Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009299:Nasal Provocation Tests; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin