Intranasal Aspirin Challenge for Diagnosis of Aspirin-Exacerbated Respiratory Disease: Symptom Score Criteria and Optimal Dosage

IF 6.6 1区医学 Q1 ALLERGY Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-07-01 Epub Date: 2025-04-03 DOI:10.1016/j.jaip.2025.03.038

Hao Xiao MS , Feng Xu MS , Qiaoru Jia BS , Li Zhang BS , Chuqi Shi BS , Jintao Du MD , Hui Yang MD, PhD , Juan Meng MD, PhD

{"title":"Intranasal Aspirin Challenge for Diagnosis of Aspirin-Exacerbated Respiratory Disease: Symptom Score Criteria and Optimal Dosage","authors":"Hao Xiao MS , Feng Xu MS , Qiaoru Jia BS , Li Zhang BS , Chuqi Shi BS , Jintao Du MD , Hui Yang MD, PhD , Juan Meng MD, PhD","doi":"10.1016/j.jaip.2025.03.038","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Aspirin-exacerbated respiratory disease (AERD) is a chronic eosinophilic inflammatory disorder characterized by asthma, chronic rhinosinusitis with nasal polyps, and intolerance to cyclooxygenase-1 inhibitors. Intranasal aspirin challenge (IAC) is increasingly used for AERD diagnosis owing to its practicality and safety. However, the lack of standardized symptom score criteria and an optimal dosage complicates its diagnostic utility.</div></div><div><h3>Objective</h3><div>To establish symptom score criteria and determine the optimal cumulative dosage for IAC in diagnosing AERD.</div></div><div><h3>Methods</h3><div>A total of 116 patients with chronic rhinosinusitis with nasal polyps were enrolled, including 58 with AERD and 58 without it. Group A (n = 70, 35 AERD and 35 non-AERD) was used to establish the symptom score criteria, which were validated in group B (n = 46, 23 AERD and 23 non-AERD). Symptom severity was assessed using a visual analog scale (VAS), and diagnostic accuracy was evaluated using receiver operating characteristic curve analysis. The safety and optimal dosage of IAC were also investigated.</div></div><div><h3>Results</h3><div>The optimal cutoff value for the increase in total VAS (T-VAS) was 7.5 points, with a sensitivity of 80.0% and specificity of 97.1%. A maximal cumulative dosage of 70 mg achieved the highest diagnostic accuracy (91.3%) and sensitivity (87.0%). Nasal congestion and rhinorrhea were the most pronounced symptoms during IAC in patients with AERD. The IAC was generally well tolerated, and 4.3% of participants experienced acute worsening of asthma.</div></div><div><h3>Conclusion</h3><div>This study identifies a T-VAS increase of 7.5 points and a maximal cumulative dosage of 70 mg as optimal for diagnosing AERD via IAC, providing a reliable, safe, and practical diagnostic approach.</div></div>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":"13 7","pages":"Pages 1732-1738"},"PeriodicalIF":6.6000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Allergy and Clinical Immunology-In Practice","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213219825003010","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/3 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Aspirin-exacerbated respiratory disease (AERD) is a chronic eosinophilic inflammatory disorder characterized by asthma, chronic rhinosinusitis with nasal polyps, and intolerance to cyclooxygenase-1 inhibitors. Intranasal aspirin challenge (IAC) is increasingly used for AERD diagnosis owing to its practicality and safety. However, the lack of standardized symptom score criteria and an optimal dosage complicates its diagnostic utility.

Objective

To establish symptom score criteria and determine the optimal cumulative dosage for IAC in diagnosing AERD.

Methods

A total of 116 patients with chronic rhinosinusitis with nasal polyps were enrolled, including 58 with AERD and 58 without it. Group A (n = 70, 35 AERD and 35 non-AERD) was used to establish the symptom score criteria, which were validated in group B (n = 46, 23 AERD and 23 non-AERD). Symptom severity was assessed using a visual analog scale (VAS), and diagnostic accuracy was evaluated using receiver operating characteristic curve analysis. The safety and optimal dosage of IAC were also investigated.

Results

The optimal cutoff value for the increase in total VAS (T-VAS) was 7.5 points, with a sensitivity of 80.0% and specificity of 97.1%. A maximal cumulative dosage of 70 mg achieved the highest diagnostic accuracy (91.3%) and sensitivity (87.0%). Nasal congestion and rhinorrhea were the most pronounced symptoms during IAC in patients with AERD. The IAC was generally well tolerated, and 4.3% of participants experienced acute worsening of asthma.

Conclusion

This study identifies a T-VAS increase of 7.5 points and a maximal cumulative dosage of 70 mg as optimal for diagnosing AERD via IAC, providing a reliable, safe, and practical diagnostic approach.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

用鼻内阿司匹林诊断阿斯匹林加重呼吸系统疾病：症状评分标准和最佳剂量。

背景：阿司匹林加重呼吸系统疾病（AERD）是一种慢性嗜酸性粒细胞性炎症性疾病，以哮喘、慢性鼻窦炎伴鼻息肉（CRSwNP）和对环氧化酶-1抑制剂不耐受为特征。由于其实用性和安全性，鼻内阿司匹林激发（IAC）越来越多地用于诊断AERD。然而，缺乏标准化的症状评分标准和最佳剂量使其诊断功能复杂化。目的：建立症状评分标准，确定IAC诊断AERD的最佳累积剂量。方法：共纳入116例CRSwNP患者，其中合并AERD的患者58例，未合并AERD的患者58例。A组（n=70， AERD 35例，非AERD 35例）建立症状评分标准，B组（n=46， AERD 23例，非AERD 23例）进行验证。采用视觉模拟量表（VAS）评估症状严重程度，采用受试者工作特征（ROC）曲线分析评估诊断准确性。并对IAC的安全性和最佳用量进行了探讨。结果：总VAS （T-VAS）提高的最佳临界值为7.5分，敏感性为80.0%，特异性为97.1%。最大累积剂量为70 mg，诊断准确率（91.3%）和灵敏度（87.0%）最高。鼻塞和鼻漏是AERD患者在IAC期间最显著的症状。IAC总体耐受性良好，4.3%的参与者出现急性哮喘恶化。结论：本研究确定了T-VAS增加7.5分，最大累积剂量为70mg是通过IAC诊断AERD的最佳方法，提供了可靠、安全、实用的诊断方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.