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Nasal Ketorolac Challenge Using Acoustic Rhinometry in Patients With Aspirin-Exacerbated Respiratory Disease

Quiralte-Castillo J1, Ávila-Castellano MR1, Cimbollek S1, Benaixa P2, Leguisamo S1, Baynova K1, Labella M1, Quiralte J1

1Allergy Section, Hospital Universitario Virgen del Rocío, Sevilla, Spain
2Ear, Nose, and Throat Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain

J Investig Allergol Clin Immunol 2017; Vol 27(3) : 169-174
doi: 10.18176/jiaci.0118

Background: Safer and less time-consuming alternatives to single-blind placebo-controlled oral challenge (SBPCOC) have been sought for the diagnosis of aspirin-exacerbated respiratory disease (AERD). Nasal challenges with various nonsteroidal 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 acoustic rhinometry in patients with suspected AERD.
Methods: The study population comprised 36 patients with suspected AERD. NKC was performed with placebo (saline) and 13 mg of ketorolac sprayed as aerosol into both nostrils. A positive challenge result was defined as an increase of ≥30% in nasal symptoms (recorded using a visual analog scale) and a 30% drop in the sum of the volumes of both nasal cavities at 2-8 cm. Patients with a negative NKC result underwent SBPCOC with aspirin (cumulative dose of 750 mg).
Results: A naso-ocular reaction during NKC was detected in 21 patients. Four patients also developed mild asthma exacerbations (although only 1 experienced a decrease in FEV1 >15%). No other significant adverse events occurred. The remaining 15 patients with a negative NKC result had a negative response during aspirin SBPCOC.
Conclusion: NKC assessed using acoustic rhinometry is a reliable method for the study of patients with AERD. We suggest that NKC assessed with acoustic rhinometry was useful and safe for selection of candidates for safe oral aspirin challenge.

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