Annals of Allergy, Asthma & Immunology ( IF 5.9 ) Pub Date : 2021-01-19 , DOI: 10.1016/j.anai.2021.01.011 Amie Nguyen 1 , Bruce L Zuraw 2 , Christina Wu 3 , Alexander Kim 3 , Sandra C Christiansen 3
Background
Intranasal ketorolac has been proposed as a diagnostic test for aspirin-exacerbated respiratory disease (AERD) and a faster, safer, and reliable addition to facilitating aspirin (ASA) desensitization.
Objective
We conducted the first prospective study to dissect the impact of intranasal ketorolac incorporation during ASA desensitization vs standard oral protocols in concert with evaluating its diagnostic use for AERD.
Methods
Patients with AERD were enrolled in a prospective open-label observational study between November 2006 and August 2013. Participants selected either one of the following desensitization protocols: intranasal ketorolac 1 day before oral ASA (group 1, combined) or ketorolac challenge with greater than 2 weeks elapsing until oral ASA (group 2, washout). All patients were on a leukotriene-modifying drug (montelukast) for at least 1 week before the challenge.
Results
A total of 20 patients were enrolled: 13 in group 1 and 7 in group 2. No significant differences were seen for baseline symptom scores or forced expiratory volume in 1 second. Group 1 exhibited significant increases for the threshold dose of ASA (P = .009), the likelihood of having silent ASA desensitization (P = .01), and decreased reaction severity to oral ASA (P = .04). There were no significant differences in reaction forced expiratory volume in 1 second, the incidence of extrapulmonary symptoms, limited nasoocular reactions, rescue treatment requirements, or time to symptom resolution. There was 100% concordance between reactions to intranasal ketorolac and oral ASA for group 2, supporting its use as a diagnostic test for AERD.
Conclusion
Intranasal ketorolac is a useful diagnostic test and adjunct within the combined ketorolac/ASA protocol to achieve effective, efficient, and perhaps safer desensitization to ASA for patients with AERD.
中文翻译:
阿司匹林加重呼吸系统疾病的鼻内酮咯酸、诊断和脱敏
背景
鼻内酮咯酸已被提议作为阿司匹林加重性呼吸系统疾病 (AERD) 的诊断测试,也是促进阿司匹林 (ASA) 脱敏的一种更快、更安全和可靠的补充剂。
客观的
我们进行了第一项前瞻性研究,以剖析 ASA 脱敏与标准口服方案期间鼻内加入酮咯酸的影响,并评估其对 AERD 的诊断用途。
方法
AERD 患者在 2006 年 11 月至 2013 年 8 月期间参加了一项前瞻性开放标签观察性研究。 参与者选择了以下脱敏方案之一:口服 ASA 前 1 天鼻内酮咯酸(第 1 组,组合)或酮咯酸挑战大于 2数周直到口服 ASA(第 2 组,洗脱)。所有患者在攻击前至少服用了 1 周的白三烯修饰药物(孟鲁司特)。
结果
总共招募了 20 名患者:第 1 组 13 名和第 2 组 7 名。基线症状评分或 1 秒用力呼气量没有显着差异。第 1 组的 ASA 阈值剂量 ( P = .009)、无症状 ASA 脱敏的可能性 ( P = .01) 以及对口服 ASA 的反应严重程度降低 ( P = .04)表现出显着增加。在 1 秒内反应用力呼气量、肺外症状的发生率、有限的鼻眼反应、抢救治疗要求或症状消退的时间方面没有显着差异。第 2 组对鼻内酮咯酸和口服 ASA 的反应之间存在 100% 的一致性,支持将其用作 AERD 的诊断测试。
结论
鼻内酮咯酸是一种有用的诊断测试,也是酮咯酸/ASA 联合方案中的一种辅助手段,可有效、高效且可能更安全地使 AERD 患者对 ASA 脱敏。