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AERD: A Composite Symptom Score to Identify Positive Aspirin/NSAID Challenges
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Kevin A. Cook, MD, Nathan Wineinger, PhD, Kristen M Dazy, MD, Katharine M. Woessner, MD FAAAAI, Ronald A. Simon, MD FAAAAI, Andrew White, MD, FAAAAI
Rationale: The gold standard for diagnosing aspirin exacerbated respiratory disease is by aspirin/NSAID challenge with the development of symptoms, or decrease in FEV1 or NIF.  There is currently no validated symptom score to assist in objectively identifying a positive challenge based on symptoms alone.

Methods: Retrospective chart review was performed on 47 patients who had undergone aspirin desensitization.  Patients had recorded symptoms during desensitization (nasal congestion, runny nose, sneezing, itchy nose, itchy/watery eyes, itchy ears, itchy mouth/tongue, tight throat, wheezing, chest tightness) at hourly intervals using a scale of 0 to 10.  Positive reactions had been identified by a supervising allergist utilizing reported symptoms as well as objective changes in FEV1 or NIF.  A composite scoring system was derived using the sum of weighted individual symptom scores.

Results: All symptoms were independently (all p<0.05) and jointly (p=7.74x10-16) associated with a positive challenge. Scores for sneezing and itchy/watery eyes were most strongly predictive of a positive challenge with odds ratios of 2.38 and 2.03 respectively for a one unit increase in score.  The weighted composite symptom score demonstrated strong association with positive challenges with an area under the curve of 0.88.  A low composite score threshold yielded a 91% sensitivity and 64% specificity, while a high threshold yielded a 73% sensitivity and 92% specificity.

Conclusions: A composite symptom score provides a 3rd objective measure with which to identify positive challenges.  Our scoring system may be utilized to identify mild reactions, treat early symptoms prior to a severe reaction, and to provide objective measurement of symptoms in AERD research studies.