[Provocation tests in the diagnosis of acetylsalicylic acid intolerance]

Aspirin is among drugs most commonly used all over the world, therefore considerable prevalence of acetylsalicylic acid (ASA) intolerance has lately been reported. There is no in vitro test for the identification of ASA intolerance and even clear-cut clinical symptoms are not sufficient for diagnosis of ASA intolerance. Provocation tests therefore, remain to be the only relevant method used for the diagnosis of both AIAR (aspirin-intolerant asthma and rhinitis) and ASA intolerance of organs other than respiratory tract. There are 5 types of provocation tests, depending on the route of ASA administration: oral, bronchial (inhaled), nasal and seldom used intravenous and intrabronchial challenges. The protocols used in different centers, vary not only in the ways of ASA administration, but also in doses used, duration of observation period and in criteria for evaluation of the results. We present here current principles regarding indications and contraindications for detailed challenge procedures and methodology of different ASA provocation tests. We summarized both advantages and the defects of all enumerated challenge procedures, which may be helpful for correct patient qualification, test performance and interpretation of the results.