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Diagnostic of NSAID exacerbated respiratory disease (NERD): Comparison of nasal and intravenous provocation test
Introduction Besides the anamnesis, the oral provocation test (OPT) is the gold standard for NERD diagnostic. The OPT can be associated with severe anaphylactoid reactions. The nasal provocation test (NPT) is considered safe but less reliable. Intravenous provocation testing (IVPT) is a new procedure at single centres and has not been fully investigated.
Methods In total, NPT and IVPT have been performed in 28 patients at the ENT Clinic Erlangen since 12/2018 and the results have been compared. The test was performed at least 6-8 weeks after surgical treatment of a CRSwP. NPT was performed according to EAACI criteria with lysine aspirin using peak nasal inspiratory flow (PNIF) and symptom-related visual analogue scale (VAS). On the following day, IVPT was performed with Aspirin®. The application was continuous up to a cumulative dose of maximum 500mg over maximum 100min. The pulmonary peak expiratory flow (PEF) and an organ-related VAS were documented. A PEF decrease>20 % or VAS increase >55mm was evaluated positively.
Results In 92 % of all patients a controlled asthma was present. 82 % reacted to NSAIDs anamnestically. The NPT was positive in only 3.6 % of the patients, but 39.1 % had late nasal symptoms. However, IVPT was positive in 69.6 % of patients and was performed on normal ward without complications.
Conclusion Despite the small number of cases, the low rate of positive reactions in NPT seems to confirm the literature regarding its lower value in NERD diagnostic. On the other hand, IVPT showed to be a safe and much more reliable method. In addition, the IVPT can be used to find the dose for a subsequent oral tolerance induction.
Article published online:
10 June 2020
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