Intranasal Aspirin Challenge for Diagnosis of Aspirin-Exacerbated Respiratory Disease: Symptom Score Criteria and Optimal Dosage.

Abstract

Aspirin-exacerbated respiratory disease (AERD) is a chronic eosinophilic inflammatory disorder characterized by asthma, chronic rhinosinusitis with nasal polyps, and intolerance to cyclooxygenase-1 inhibitors. Intranasal aspirin challenge (IAC) is increasingly used for AERD diagnosis owing to its practicality and safety. However, the lack of standardized symptom score criteria and an optimal dosage complicates its diagnostic utility. To establish symptom score criteria and determine the optimal cumulative dosage for IAC in diagnosing AERD. A total of 116 patients with chronic rhinosinusitis with nasal polyps were enrolled, including 58 with AERD and 58 without it. Group A (n = 70, 35 AERD and 35 non-AERD) was used to establish the symptom score criteria, which were validated in group B (n = 46, 23 AERD and 23 non-AERD). Symptom severity was assessed using a visual analog scale (VAS), and diagnostic accuracy was evaluated using receiver operating characteristic curve analysis. The safety and optimal dosage of IAC were also investigated. The optimal cutoff value for the increase in total VAS (T-VAS) was 7.5 points, with a sensitivity of 80.0% and specificity of 97.1%. A maximal cumulative dosage of 70 mg achieved the highest diagnostic accuracy (91.3%) and sensitivity (87.0%). Nasal congestion and rhinorrhea were the most pronounced symptoms during IAC in patients with AERD. The IAC was generally well tolerated, and 4.3% of participants experienced acute worsening of asthma. This study identifies a T-VAS increase of 7.5 points and a maximal cumulative dosage of 70 mg as optimal for diagnosing AERD via IAC, providing a reliable, safe, and practical diagnostic approach.