[Rhinitis with intolerance to non-steroidal anti-inflammatory agents. Report of 3 cases]

Lumry described 6 patients who presented hypertrophic rhinosinusitis, positive nasal eosinophilia and intolerance to nonsteroidal antiinflammatory drugs, manifested exclusively with naso-ocular symptomatology. We present three patients with clinical manifestations of chronic rhinitis who had noticed before their first visit that several nonsteroidal antiinflammatory drugs precipitated their nasal symptomatology. None of them had ever presented with asthma symptoms. All of them had nasal polyps. The nasal smear showed eosinophilia of 20 to 45%. All three had sinusitis radiologically. The spirometric values were within normal limits (V.C., FEV1, MMEF25-75%). Skin tests with different inhalants antigens using the prick test technique as well as skin tests with pyrazolones (Phenyldimetrylpyrazolone: 25 and 250 mg./ml.; dipyrone: 4 and 44 mg./ml.; amidopyrine: 2.2 and 22 mg./ml.) using the intradermal technique were negative. Serum IgE (Phadezym IgE-Pharmacia) showed values of 23.9, 17.1 and 25.8 IU/ml. respectively. The bronchial inhalation challenge test with methacholine was positive with PD20FVE1 of 14 and 4.8 mg./ml. in two of our patients. Different nonsteroidal antiinflammatory drugs were administered to each patient in different days orally, with intervals of 7 and 25 days (aspirin 500 mg., dipyrone 575 mg., indomethacin 25 mg., naproxen 500 mg.) as well as tartrazine (50 mg.), paracetamol (500 mg.) and lactose as placebo. With 30 minutes intervals and up to three hours after drug administration, the symptoms were observed and spirometry was carried out. Steroids and antihistamines were suspended at least 48 hours before the test. Acetyl-salicylic acid, dipyrone, indomethacin and naproxen produced naso-ocular symptomatology without any objective reduction of FEV1; but paracetamol and tartrazine were well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)