The relationship between historical aspirin-induced asthma and severity of asthma induced during oral aspirin challenges

BackgroundHistorical aspirin- or nonsteroidal anti-inflammatory drug (NSAID)–induced reactions might provide predictive information about the severity of reactions in patients with aspirin-exacerbated respiratory disease (AERD) undergoing oral aspirin challenge (OAC).ObjectiveWe sought to assess the relationship between historical aspirin- or NSAID-induced bronchial reactions and the severity of bronchial reactions during OAC in patients with AERD.MethodsData regarding the provoking doses, treatments, and treatment settings of historical aspirin/NSAID-induced reactions were recorded, analyzed, and compared with the provoking doses, maintenance regimens, and observed decreases in FEV1 that occurred during OAC in 210 consecutive patients referred with suspected AERD.ResultsOf 147 patients who reported seeking acute medical care for their historical aspirin/NSAID-induced asthma attacks, 101 (69%) were treated in an emergency department and released, and 46 (31%) required hospitalization. During OAC in these 147 subjects, 23 (16%) had a 20% to 29% decrease and 14 (10%) had a 30% or greater decrease in FEV1 values from baseline. Of the 46 patients previously hospitalized for aspirin/NSAID-induced asthma attacks, 9 (20%) had a 20% to 29% decrease and 6 (13%) had a 30% or greater decrease in FEV1 during OAC. By contrast, of the 63 patients who treated their prior aspirin/NSAID-induced reactions at home, 5 (8%) had a 20% to 29% decrease and 5 (8%) had a 30% or greater decrease in FEV1 during OAC (P = not significant for both).ConclusionThe severity of the historical aspirin/NSAID-induced asthma attack was not predictive of asthma severity during OAC.Clinical implicationsThese data provide further reassurance regarding the safety of outpatient aspirin desensitization.