Aspirin and tartrazine oral challenge: Incidence of adverse response in chronic childhood asthma

Reports of adverse response to acetylsalicylic acid (ASA) and tartrazine in asthma disagree widely on the incidence of these phenomena. The present study seeks to define these incidences for asthmatic children in a statistically acceptable, standardized, and simple fashion. Fifty-four chronic asthmatic children 10 to 17 yr of age underwent blinded oral provocation challenge with ASA, tartrazine, and placebo on separate days. The pulmonary function results were expressed in percent predicted units and the absolute change from the subject's baseline to ASA and tartrazine were compared to the normal variation encountered to placebo challenge. Five children developed sustained decreases of one-second forced expiratory volume (L) (FEV₁) or forced expiratory flow rate at 25% to 75% of effort (L/sec) (FEF_0.25–0.75) exceeding 2 SD of the group mean response to placebo following oral ASA; none did following tartrazine. Two additional patients included in this population sample were considered to have adverse pulmonary response (APR) by history and were consequently not challenged. There were no clinical or laboratory findings associated with APR to ASA. Adverse response to ASA is sufficiently common among our population of children with chronic asthma to warrant ASA avoidance, unless ASA therapy is needed for another condition, such as rheumatoid arthritis, in which case careful provocation testing should be considered.