EFFICACY AND SAFETY OF A THREE-STEP ASPIRIN CHALLENGE PROTOCOL IN A MONITORED CLINIC SETTING

Abstract

Introduction

Aspirin challenge is the gold standard procedure to diagnose aspirin-exacerbated respiratory disease in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and an unclear history of aspirin/NSAID drug reactions. The goal of this study is to establish the efficacy and safety of a 3-step in-clinic aspirin challenge protocol.

Methods

From 2016-2023, 145 patients with CRSwNP and asthma underwent aspirin challenge. Increasing aspirin dosages, from 30 to 325 mg, were administered with a 60-minute (after 30 mg), 90-minute (after 81 mg), and 3-hour (after 325 mg) dosing interval in clinic. Patient demographics, vitals, symptoms and symptom scores, FEV1, peak nasal inspiratory flow rate (PNIFR), and treatments administered were analyzed. A positive reaction was defined as an increased symptom score ≥5 points from baseline, decreased FEV1 by ≥15%, or decreased PNIFR by ≥20%.

Results

Among 145 patients, 67 (46.2%) had positive challenges. The most common provoking dose was 30 mg (47.8%), followed by 81 mg (43.3%). Among reactors, symptoms usually presented at the 1-hour (n=26, 38.8%) or 2-hour timepoint (n=18, 26.9%). From baseline to nadir, mean decrease in FEV1 was 8.9%, and mean decrease in PNIFR was 24.5%. The most common symptoms were nasal congestion (n=51, 76.1%) and rhinorrhea (n=23, 34.3%). Epinephrine was infrequently required (n=9, 13.4%). No patients required ED transfer or hospitalization, and mean challenge duration was 4.76 hours.

Conclusion

With a mean duration <5 hours and excellent safety profile, our study demonstrates an efficient, 3-step aspirin challenge protocol that was safely performed in an outpatient clinic setting.