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Allergy Frontiers: Diagnosis and Health Economics pp 349–372Cite as

Diagnosis of Aspirin Sensitivity in Aspirin Exacerbated Respiratory Disease

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Part of the book series: Allergy Frontiers ((ALLERGY,volume 4))

Ingestion of aspirin or other non-steroidal anti-inflammatory drug (NSAID) may induce a severe asthmatic attack in a subpopulation of asthmatic patients. The reaction is not immunological but is related to inhibition by aspirin of cyclooxygenase-1, which triggers a mechanism leading to asthmatic attack.

And although in majority of ASA-sensitive patients history of drug- induced adverse reaction is quite convincing it is not always reliable and in several instances confirmation by in vitro tests and/or controlled aspirin challenge is necessary. Oral challenge is the gold standard for the diagnosis but nasal or bronchial provocation with lysine-ASA may be a valuable alternative to confirm drug hypersensitivity in asthmatic patients

In vitro tests to distinguish aspirin sensitive from insensitive individuals have not been standardized, but maybe helpful if experienced hands. Assessment of increased expression of CD63 on peripheral blood leukocyte following in vitro stimulation with aspirin or measurement of aspirin-triggered 15-HETE release from PBL (ASPITest) may be valuable tools to confirm aspirin sensitivity.

Diagnosis of ASA-hypersensitivity should be followed by patient's education and careful avoidance of ASA and NSAIDs. Selective cyclooxygenase-2 inhibitors (e.g. celecoxib) may be safe and effective alternative for treatment in ASA-sensitive patients if analgesic and anti-inflammatory treatment is indicated

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  1. Department of Immunology, Rheumatology and Allergy, Chair of Immunology, Faculty of Medicine, Medical University of Łódz, Łódz, Poland

    Marek L. Kowalski

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  1. Marek L. Kowalski
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  1. Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan

    Ruby Pawankar

  2. Southampton General Hospital, University of Southampton, Tremona Road, Southampton, UK

    Stephen T. Holgate

  3. UMKC School of Medicine, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Lanny J. Rosenwasser

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Kowalski, M.L. (2009). Diagnosis of Aspirin Sensitivity in Aspirin Exacerbated Respiratory Disease. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Diagnosis and Health Economics. Allergy Frontiers, vol 4. Springer, Tokyo. https://doi.org/10.1007/978-4-431-98349-1_20

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