Elina Jerschow1, Zhen Ren2, Golda Hudes3, Marek Sanak4, Esperanza Morales5, Victor Schuster3, Simon D Spivack3, David Rosenstreich3. 1. Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York. Electronic address: Elina.Jerschow@einstein.yu.edu. 2. Jacobi Medical Center, Bronx, New York. 3. Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York. 4. Jagiellonian University Medical College, Krakow, Poland. 5. Ferkauf Graduate School of Psychology at Yeshiva University, Bronx, New York.
Abstract
BACKGROUND: Aspirin-exacerbated respiratory disease (AERD) is diagnosed through graded aspirin challenges that induce hypersensitivity reactions and eicosanoid level changes. It is not known whether diagnostically useful changes also occur after low-dose aspirin challenges that do not induce hypersensitivity reactions. OBJECTIVE: To investigate the utility of low-dose oral aspirin challenges for diagnosing AERD by measuring different clinical parameters and eicosanoid changes. METHODS: Sixteen patients with AERD and 13 patients with aspirin-tolerant asthma underwent oral challenges with low-dose (20 or 40 mg) aspirin and diagnostic oral graded aspirin challenges (up to 325 mg of aspirin). Forced expiratory volume in 1 second, nasal peak flow, the fraction of exhaled nitric oxide (FeNO), and eicosanoid levels in plasma and urine were analyzed. RESULTS: In patients with AERD but not in those with aspirin-tolerant asthma, 40-mg aspirin challenges induced a significant mean (SEM) decrease from baseline in FeNO (19% [5.1%]; P = .001) without causing any hypersensitivity reaction. The FeNO decrease also occurred after higher-dose aspirin challenges (27.8% [4.9%]; P < .001). The sensitivity and specificity of 40-mg aspirin-induced FeNO changes for identifying AERD were 90% and 100% with an area under the curve of 0.98 (95% CI, 0.92-1.00). The low-dose challenge also induced a significant leukotriene E4 urine increase in patients with AERD (from 6.32 [0.08] to 6.91 [0.15] log-pg/mg creatinine; P < .001), but the sensitivity and specificity of these changes were less than for the FeNO changes. CONCLUSION: The low-dose aspirin-induced decrease in FeNO in patients with AERD may be useful for the diagnosis of aspirin allergy without inducing a hypersensitivity reaction. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01320072.
BACKGROUND:Aspirin-exacerbated respiratory disease (AERD) is diagnosed through graded aspirin challenges that induce hypersensitivity reactions and eicosanoid level changes. It is not known whether diagnostically useful changes also occur after low-dose aspirin challenges that do not induce hypersensitivity reactions. OBJECTIVE: To investigate the utility of low-dose oral aspirin challenges for diagnosing AERD by measuring different clinical parameters and eicosanoid changes. METHODS: Sixteen patients with AERD and 13 patients with aspirin-tolerant asthma underwent oral challenges with low-dose (20 or 40 mg) aspirin and diagnostic oral graded aspirin challenges (up to 325 mg of aspirin). Forced expiratory volume in 1 second, nasal peak flow, the fraction of exhaled nitric oxide (FeNO), and eicosanoid levels in plasma and urine were analyzed. RESULTS: In patients with AERD but not in those with aspirin-tolerant asthma, 40-mg aspirin challenges induced a significant mean (SEM) decrease from baseline in FeNO (19% [5.1%]; P = .001) without causing any hypersensitivity reaction. The FeNO decrease also occurred after higher-dose aspirin challenges (27.8% [4.9%]; P < .001). The sensitivity and specificity of 40-mg aspirin-induced FeNO changes for identifying AERD were 90% and 100% with an area under the curve of 0.98 (95% CI, 0.92-1.00). The low-dose challenge also induced a significant leukotriene E4 urine increase in patients with AERD (from 6.32 [0.08] to 6.91 [0.15] log-pg/mg creatinine; P < .001), but the sensitivity and specificity of these changes were less than for the FeNO changes. CONCLUSION: The low-dose aspirin-induced decrease in FeNO in patients with AERD may be useful for the diagnosis of aspirinallergy without inducing a hypersensitivity reaction. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01320072.
Authors: P Sestini; L Armetti; G Gambaro; M G Pieroni; R M Refini; A Sala; A Vaghi; G C Folco; S Bianco; M Robuschi Journal: Am J Respir Crit Care Med Date: 1996-02 Impact factor: 21.405
Authors: Elina Jerschow; Matthew L Edin; Yuling Chi; Beth Hurst; Waleed M Abuzeid; Nadeem A Akbar; Marc Gibber; Marvin P Fried; Weiguo Han; Teresa Pelletier; Zhen Ren; Taha Keskin; Gigia Roizen; Fred B Lih; Artiom Gruzdev; J Alyce Bradbury; Victor Schuster; Simon Spivack; David Rosenstreich; Darryl C Zeldin Journal: J Allergy Clin Immunol Pract Date: 2018-12-21
Authors: Whitney W Stevens; Elina Jerschow; Alan P Baptist; Larry Borish; John V Bosso; Kathleen M Buchheit; Katherine N Cahill; Paloma Campo; Seong H Cho; Anjeni Keswani; Joshua M Levy; Anil Nanda; Tanya M Laidlaw; Andrew A White Journal: J Allergy Clin Immunol Date: 2020-12-09 Impact factor: 10.793