Diagnosis and treatment of AERD: clinical practice realities

RATIONALE: Aspirin-exacerbated respiratory disease (AERD), characterized by the triad of asthma, rhinosinusitis with nasal polyps and aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) hypersensitivity, may be suggested by history, however, the oral provocation test with aspirin is the gold standard for diagnosis. The aim of this study was to assess the behavior of patients with suspected AERD who underwent aspirin challenge and/or desensitisation.

METHODS: A retrospective study using an electronic medical record for suspected AERD adult asthmatic patients that underwent aspirin provocation and/or desensitization with aspirin. All patients had nasal polyposis. Two protocols have been used for aspirin provocation test: a) nasal ketorolac and oral aspirin and b) only oral aspirin. The clinical characteristics, test positivity and type of aspirin‘s reaction were assessed.

RESULTS: Twenty-three patients, with a mean age of 51.3 years were included in this study. Five patients had allergic asthma. Mean FEV1 was 82.0% of predicted value. Eighteen patients (78.3%) presented bronchospasm and/or urticaria with NSAIDs. Five patients did not develop any reaction. Regardless of the protocol used, ten patients (43.5%) presented positive test, confirming AERD, and five of them (50.0%) were submitted to desensitisation with aspirin. Thirteen patients (56.5%) presented negative provocation test and 3 of them (13.0%), could not complete the investigation due to urticaria.

CONCLUSIONS: Patients with suspected AERD should be submitted to aspirin provocation to confirm the diagnosis. In this study, more than half of the patients presented negative test and a small percentage of them did not complete the provocation test due to cutaneous reaction to aspirin.