Nasal Challenge Tests with Acetylsalicylic Lysine in Patientswith Nasal Polyposis - Method

Overview

The authors describe the method of the nasal challenge test for assessment ofacetylsalicylic acid (ASA) intolerance. This test was made in 50 patients with nasal polyps withoutanamnestic records of ASA intolerance, incl. 23 who had nasal polyps associated with bronchialasthma. The test was made also in 10 healthy controls. In all patients for two weeks before the testall treatment of rhinosinusitis was discontinued, treatment of bronchial asthma proceeded,The challenging agent was a freshly prepared solution of acetylsalicylic lysine, Aspegic (Synthéla-bo). The total dose during the challenge test was 9 mg lysine (corresponds to 5 mg acetylsalicylicacid) administered bilaterally. As placebo saline was administered. For administration a dispenserfrom Syntaris spray was used.During the test the nasal patency was evaluated by anterior active rhinomanometry. The basicobjectively assessed parameter was the nasal flow in ml/s bilaterally at a pressure difference of 75Pa. The patients recorded subjective sensations of nasal patency, nasal secretion and the feeling ofdyspnoea on a ten-centimeter visual scale.The measurements were taken 25 and 50 minutes after administration acetylsalicylic lysine (lys-ASA). The test was evaluated as positive if after unilateral administration of lys-ASA a 40% declineof the nasal patency occurred and this drop was associated with a subjective change of nasal patency, nasal secretion of lacrimation. The test was evaluated as positive if bilateral drop of nasalpatency by 40% or more occurred even if subjective changes were absent.The test was evaluated as negative, if no drop occurred on either side by 40 % or more. The test wasevaluated as negative if a drop by 40 % of more occurred after placebo, when after administrationof lys-ASA no further drop greater than 40 % occurred. The test was evaluated as negative if the flowvalue did not decline even when the patient reported subjectively perceived increased nasalsecretion after administration of lys-ASA.The test could not be evaluated in two patients where already during the first measurements thenasal patency was very restricted, and in another six patients because of increased nasal sensitivitywhere after administration of placebo a drop by 40% or more occurred at least on one side and afteradministration of lys-ASA a further drop by 40% or more.In the control group of 10 volunteers the test was always negative. The change after placebo was inall smaller than 40 %.None of the patients developed bronchoconstriction, no drop of FEV1 or subjective despnoea wererecorded.

Key words:
nasal challenge test, lysine aspirin, aspirin intolerance, nasal polyps.