Intranasal ketorolac,diagnosis, and desensitization for aspirin-exacerbated respiratory disease |
| |
| Authors: | Amie Nguyen Bruce L. Zuraw Christina Wu Alexander Kim Sandra C. Christiansen |
| |
| Affiliation: | 1. Department of Allergy and Immunology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California;2. Department of Medicine, University of California San Diego, La Jolla, California;3. Section of Rheumatology and Allergy Medicine Service, Veterans Affairs San Diego Healthcare System, San Diego, California;1. Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York;2. Gerber, Nestlé Nutrition, Arlington, Virginia;3. RTI International, Research Triangle Park, North Carolina;4. Allergy and Immunology, Department of Pediatrics, NYU Langone Health, New York, New York;6. Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland;1. Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania;2. Division of Pulmonary, Critical Care, and Sleep Medicine, Einstein Medical Center, Philadelphia, Pennsylvania;3. Department of Medicine, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, Pennsylvania;1. The Medical College of Georgia at Augusta University, Augusta University/University of Georgia Medical Partnership, Athens, Georgia;2. Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia;3. Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia;1. Division of Pediatric Allergy and Immunology, Ankara City Hospital, Ankara, Turkey;2. Department of Child and Adolescent Psychiatry, University of Health Sciences, Ankara City Hospital, Ankara, Turkey;3. Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey;1. Department of Pharmacokinetics, Pharmacodynamics, Modeling and Simulation, ICON plc, Marlow, United Kingdom;2. Department of Clinical Research and Medical Affairs, Pharming Healthcare Inc, Warren, New Jersey;3. Clinical Research Center of Alabama, Alabama Allergy and Asthma Center, Birmingham, Alabama |
| |
| Abstract: | BackgroundIntranasal 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.ObjectiveWe 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.MethodsPatients 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.ResultsA 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.ConclusionIntranasal 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. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
