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Nasal ketorolac challenge using an acoustic rhinomether in patients with aspirin-exacerbated respiratory disease

Quiralte-Castillo J, del Robledo Ávila-Castellano M, Cimbollek S, Benaixa P, Leguisamo S, Baynova K, Labella M, Quiralte J

Allergy Section and 1Ear, nose and Throat Service. Hospital Universitario Virgen del Rocío. Sevilla. Spain

J Investig Allergol Clin Immunol 2016; Vol. 27(3)
doi: 10.18176/jiaci.0118

Background: Safer and less time consuming alternatives to single-blind placebo-controlled oral challenge (SBPCOC) in order to diagnose aspirin-exacerbated respiratory disease (AERD) have been searched for. Nasal challenges with different non-steroidal anti-inflammatory drugs and assessment methods have been developed.
Objective: Our objective was to evaluate the utility and safety of nasal ketorolac challenge (NKC) using an acoustic rhinomether in patients with suspected AERD
Methods: Thirty-six patients with suspected AERD were included in the study. NKC was performed with placebo (saline) and 13 mg of ketorolac sprayed as aerosol into both nostrils. A positive challenge was defined as an increase of 30% or greater of nasal symptoms recorded by a visual analog scale and a 30 % drop in the sum of both nasal cavities volume at the level of 2 to 8 cm. SBPCOC with 750 mg of aspirin (in accumulative doses) was carried out in those patients who showed a negative NKC.
Results: Twenty-one patients with suspected AERD had nasoocular reaction during NKC. Four patients of them also developed a mild asthma exacerbations (although only one showed a FEV1 decline >15 %) but no other significative adverse events occurred. The remaining 15 patients who had a negative NKC showed a negative response during aspirin SBPCOC.
Conclusion: NKC assessed by acoustic rhinomether is a reliable method to study patients with AERD. We also suggested that the combination of NKC assessed with acoustic rhinomether was useful a safe in order to select patients suitable to undergo a safe oral aspirin challenge.

Key words: Ketorolac, Nasal challenge, Aspirin exacerbated respiratory disease.