Nasal Ketorolac Challenge Using Acoustic Rhinometry in Patients With Aspirin-Exacerbated Respiratory Disease

Area of Science:

• Allergy and Immunology
• Otolaryngology
• Pulmonology

Background:

• Diagnosing aspirin-exacerbated respiratory disease (AERD) traditionally involves single-blind placebo-controlled oral challenge (SBPCOC), which can be time-consuming and less safe.
• Development of nasal challenges with nonsteroidal anti-inflammatory drugs (NSAIDs) and objective assessment methods offers potential alternatives.

Purpose of the Study:

• To evaluate the safety and utility of nasal ketorolac challenge (NKC) using acoustic rhinometry for diagnosing AERD.
• To assess NKC as a potential alternative to SBPCOC.

Main Methods:

• Thirty-six patients with suspected AERD underwent NKC using saline (placebo) and 13 mg ketorolac nasal aerosol.
• Positive NKC was defined by ≥30% increase in nasal symptoms and ≥30% decrease in nasal cavity volume.
• Patients with negative NKC proceeded to aspirin SBPCOC.

Main Results:

• Naso-ocular reactions occurred in 21 patients during NKC.
• Four patients experienced mild asthma exacerbations; one had a significant FEV1 decrease.
• Fifteen patients with negative NKC also had negative aspirin SBPCOC results.

Conclusions:

• Nasal ketorolac challenge (NKC) assessed with acoustic rhinometry is a reliable and safe method for evaluating patients with suspected AERD.
• NKC can effectively identify candidates for subsequent safe oral aspirin challenges.