Two patterns of changes in nasal nitric oxide after lysine aspirin nasal challenge in patients with aspirin-exacerbated respiratory disease.
BACKGROUND
Nasal nitric oxide (nNO) levels after nasal lysine acetylsalicylic acid (lys-ASA) challenge have not been determined. This study was designed to determine a pattern of changes after lys-ASA challenge in aspirin-exacerbated respiratory disease (AERD) patients and  to evaluate the usefulness of nNO measurements in the assessment of lys-ASA nasal challenge outcome.


METHODS
Eighteen patients with aspirin hypersensitivity, nasal polyps, and asthma were included. Aspirin-tolerant control groups consisted of 10 healthy volunteers without  asthma and nasal polyps and 10 patients with nasal polyps without asthma. All subjects underwent nasal challenge with lys-ASA. nNO was measured before and 1, 2, 4, and 24 hours after control solution and lys-ASA administration.


RESULTS
A significant fall in nNO levels  was noted in AERD patients with a positive result to challenges at time points 1 hour (p = 0.0033), 2 hours (p = 0.0033), and 3 hours (p = 0.026) after lys-ASA. A trend toward higher nNO concentrations was observed after lys-ASA challenge at the 2-hour (p = 0.018) and 4-hour (p = 0.018) time  points compared with baseline in subjects with AERD and a clinically negative result to the challenge. No significant changes in nNO levels after the challenge were observed in control groups. The combined increase and decrease in nNO levels gave the sensitivity as 0.94 and specificity 1.00  at best.


CONCLUSIONS
nNO levels decrease after lys-ASA nasal challenge in subjects with AERD and a clinically positive result of the challenge. An unexpected trend toward an increase in nNO levels is observed in subjects with AERD and a clinically negative result of the  challenge.
Division of Internal Diseases, Asthma and Allergy, Barlicki University Hospital, Lodz, Poland. damian.tworek@gmail.com
Damian
D
Tworek
Izabela
I
Kuprys-Lipinska
Wioletta
W
Pietruszewska
Piotr
P
Kuna
D000281:Administration, Intranasal; D000328:Adult; D001241:Aspirin / Q000031:analogs & derivatives*; D055963:Asthma, Aspirin-Induced / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008239:Lysine / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000737:chemistry*; D009299:Nasal Provocation Tests; D009569:Nitric Oxide / Q000032:analysis*; D010147:Pain Measurement; D016037:Single-Blind Method
D009569:Nitric Oxide; D008239:Lysine; D001241:Aspirin; C010395:acetylsalicylic acid lysinate