Respiratory Exposure Tests in Aspirin Exacerbated Respiratory Disease

Abstract

Abstract Purpose of review Controlled oral provocation test with aspirin is considered the “gold standard” for diagnosing hypersensitivity to NSAIDs (non-steroid anti-inflammatory drugs). Newer techniques of respiratory exposure tests, bronchial and nasal respectively, have been nonetheless developed, as they are safer, less likely to cause a systemic reaction, and less time-consuming than the oral provocation test with aspirin (acetyl-salicylic acid). These tests are also particularly useful when oral challenge testing is contraindicated. The aim of this paper is to review and update the detailed protocols of bronchial and nasal challenges with lysine-aspirin, a salt of acetyl-salicylic acid, more soluble and less irritative. Recent findings Current guidelines recommend standardized protocols for nasal, and especially bronchial challenge with lysine-aspirin, in patients with suspected N-ERD (NSAID-exacerbated respiratory disease). Summary Nasal and bronchial tests are useful and safe, nonetheless not that sensible as oral aspirin challenge for the diagnosis of N-ERD. So, in cases of high suspicion and negative respiratory tests, an oral challenge should be performed before ruling out the diagnosis. These techniques should be performed by trained personnel in specialized allergy clinics. Further consensus on nasal test protocol and interpretation is still needed.