Intranasal ketorolac, diagnosis, and desensitization for aspirin-exacerbated respiratory disease
| Autor: | Bruce L. Zuraw, Christina C.N. Wu, Alexander S. Kim, Amie Nguyen, Sandra C. Christiansen |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_treatment Immunology Administration Oral Young Adult 03 medical and health sciences 0302 clinical medicine Forced Expiratory Volume medicine Humans Immunology and Allergy 030212 general & internal medicine Prospective cohort study Administration Intranasal Montelukast Aged Desensitization (medicine) Asthma Aspirin business.industry Incidence (epidemiology) Anti-Inflammatory Agents Non-Steroidal Respiratory disease Middle Aged medicine.disease Ketorolac 030228 respiratory system Desensitization Immunologic Anesthesia Asthma Aspirin-Induced Female business medicine.drug |
| Zdroj: | Annals of Allergy, Asthma & Immunology. 126:674-680 |
| ISSN: | 1081-1206 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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