Intranasal ketorolac, diagnosis, and desensitization for aspirin-exacerbated respiratory disease.

Amie Nguyen, Bruce L Zuraw, Christina Wu, Alexander Kim, Sandra C Christiansen

Journal: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2021;126(6):674-680

PMID: 33476718

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Intranasal ketorolac has been proposed as a diagnostic test for aspirin-exacerbated respiratory disease (AERD) and a faster, safer, and reliable addition to facilitating aspirin (ASA) desensitization.

OBJECTIVE

We conducted the first prospective study to dissect the impact of intranasal ketorolac incorporation during ASA desensitization vs standard oral protocols in concert with evaluating its diagnostic use for AERD.

METHODS

Patients with AERD were enrolled in a prospective open-label observational study between November 2006 and August 2013. Participants selected either one of the following desensitization protocols: intranasal ketorolac 1 day before oral ASA (group 1, combined) or ketorolac challenge with greater than 2 weeks elapsing until oral ASA (group 2, washout). All patients were on a leukotriene-modifying drug (montelukast) for at least 1 week before the challenge.

RESULTS

A total of 20 patients were enrolled: 13 in group 1 and 7 in group 2. No significant differences were seen for baseline symptom scores or forced expiratory volume in 1 second. Group 1 exhibited significant increases for the threshold dose of ASA (P = .009), the likelihood of having silent ASA desensitization (P = .01), and decreased reaction severity to oral ASA (P = .04). There were no significant differences in reaction forced expiratory volume in 1 second, the incidence of extrapulmonary symptoms, limited nasoocular reactions, rescue treatment requirements, or time to symptom resolution. There was 100% concordance between reactions to intranasal ketorolac and oral ASA for group 2, supporting its use as a diagnostic test for AERD.

CONCLUSION

Intranasal ketorolac is a useful diagnostic test and adjunct within the combined ketorolac/ASA protocol to achieve effective, efficient, and perhaps safer desensitization to ASA for patients with AERD.

Address: Department of Allergy and Immunology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; Department of Medicine, University of California San Diego, La Jolla, California.; Department of Medicine, University of California San Diego, La Jolla, California; Section of Rheumatology and Allergy Medicine Service, Veterans Affairs San Diego Healthcare System, San Diego, California.; Department of Medicine, University of California San Diego, La Jolla, California.; Department of Medicine, University of California San Diego, La Jolla, California. Electronic address: [email protected].

DOI: 10.1016/j.anai.2021.01.011

Link outs

Free resources

Other Literature Sources:

https://scite.ai/reports/33476718

Subscription / membership required

Full Text Sources:

MeSH Terms: Administration, Intranasal, Administration, Oral, Adult, Aged, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Asthma, Aspirin-Induced, Desensitization, Immunologic, Female, Forced Expiratory Volume, Humans, Ketorolac, Male, Middle Aged, Young Adult