Nasal provocation tests with lysine aspirin

Provocation tests with aspirin reliably prove aspirin hypersensitivity in patients with a history of prior reaction to non-steroidal anti-inflammatory drugs. The nasal provocation test with lysine-aspirin was introduced into clinical practice in the late 1980s. It is a valuable screening test in patients with aspirin hypersensitivity restricted to the upper airway and in those with severe asthma in whom oral and bronchial aspirin challenges are contraindicated. Nasal challenge with lysine-aspirin is relatively simple, cheap and quite easy to be supervised in a hospital outpatient clinic. A positive nasal reaction is defined as the appearance of clinical symptoms such as rhinorrhoea, sneezing and nasal congestion combined with significant decreases in some parameters of rhinomanometry, acoustic rhinometry and/or peak inspiratory flows. However, a negative nasal challenge should be followed by the oral aspirin test. The detailed protocol of the nasal provocation test with lysine-aspirin is presented in this article

A case of an adenoid cystic carcinoma of trachea in a young female

A case of an adenoid cystic carcinoma of trachea is presented. A 30-year-old non-smoking woman with strong inspiratory dyspnea at rest was admitted to the Dept, of Pulmonary Diseases. At auscultation a respiratory murmur was more silent at right lung and stridor over trachea was heard. CT scan revealed tumor at the bifurcation of the trachea. Bronchoscopy was made and biopsy established the diagnosis: adenoid cystic carcinoma. The tumor was partially removed with rigid bronchoscope and radiotherapy was started. Clinical improvement occurred; in control CT scan tumor vanished. The trachea cancers are rare. Symptoms often mimic asthma or chronic bronchitis. Thus in every patient with chronic cough and dyspnea bronchoscopy should be made. A treatment of choice is primary resection and postoperative radiotherapy

Standards of nasal provocation tests

The nasal allergen provocation test (NAPT) plays an important role in diagnosis of allergy. It is based on the natural reaction of the nasal mucosa after application of tested substances on their surface. Nasal challenges are divided into specific (allergenic) and non-specific. Typical clinical symptoms depend on the immunological reaction: sneezing, itching, rhinorrhea and nasal blockage. Eosinophilic mucosal infiltration is observed in the late phase reaction. Typically the result of nasal challenge should be assessed by the physician and patient. The immunological reaction, especially the level of particular allergenic mediators, could also be investigated. Some objective methods for final assessment of the results are recommended. There is some information about non-specific nasal provocation with aspirin and occupational diseases in the pape

Nasal versus bronchial and nasal response to oral aspirin challenge : clinical and biochemical differences between patients with aspirin-induced asthma/rhinitis

Background: Aspirin-induced asthma/rhinitis (AIAR) is characterized by the altered metabolism of leukotrienes and proinflammatory prostaglandins. The basal and postchallenge levels of eicosanoids might reflect the clinical and biochemical characteristics of patients with distinct types of hypersensitive responses to aspirin. Objective: We compared clinical and eicosanoid profiles of patients with AIAR showing both bronchial and nasal versus isolated nasal responses to aspirin challenge. Methods: Twenty-three patients with AIAR underwent the single-blind, oral, placebo-controlled aspirin challenge. The bronchial response (BR) was evidenced by dyspnea and spirometry, whereas the nasal response (NR) was evidenced by nasal symptoms and acoustic rhinometry and/or rhinomanometry. Urinary leukotriene E4 (uLTE4), serum and urinary stable prostaglandin D2 metabolite, and 9α,11β-prostaglandin F2 (9α,11β-PGF2), were determined at baseline and after the aspirin challenge. Results: Fifteen subjects showed BR and NR (BNR), whereas 8 showed NR only. Basal uLTE4 in the BNR group was significantly higher than in the NR group. After aspirin challenge, it increased significantly in both groups. Serum 9α,11β-PGF2 increased after aspirin challenge in the BNR group only. The patients with BNR had more severe AIAR. Conclusions: BNR to aspirin in AIAR indicates a more advanced disease and more profound underlying eicosanoid metabolism disturbances

Systemic expression of inflammatory mediators in patients with chronic rhinosinusitis and nasal polyps with and without Aspirin Exacerbated Respiratory Disease

Background: Systemic reactions are related to the pathogenesis of Aspirin Exacerbated Respiratory Disease (AERD). With this work we wanted to study the changes in the systemic levels of inflammatory mediators in both baseline and after oral aspirin challenge in patients with and without AERD. Methods: Patients with nasal polyposis and asthma with AERD (n = 20) and without (n = 18) were orally challenged with aspirin in a single-blind placebo controlled study. Serum samples and urine were collected before and 6 h after placebo and aspirin oral challenges. Serum levels of inflammatory mediators were assayed by using the Luminex technology and ELISA. The concentrations of 9-alpha, 11-beta prostaglandin F-2, and leukotriene E-4 (uLTE(4)) were measured in urine samples by ELISA. The expression of T-cell surface markers was analyzed in peripheral blood mononuclear cells isolated before and after the challenges. Results: AERD patients showed significantly higher baseline levels of s-IL-5R-alpha, uLTE(4) and percentage of CD4(+)CD25(+)CD127(pos) and CD4(+)CD45RA(-)CD45RO(+) but decreased levels of TGF-beta(1) and number of CD4(+)CD25(+)CD127(neg) cells. Aspirin challenge induced the release of uLTE4, IL-6 and increased the number of CD4(+)CD45RA(-)CD45RO(+) memory T-cells only in AERD patients but failed to reduce the levels of sCD40L as observed in non-AERD subjects. Further, IL-8 and sIL-5R-alpha levels directly correlated with the PD(20)ASA and the effects of aspirin on IL-6 and number of memory T-cells was more pronounced in subjects showing more strong reaction (bronchial and nasal). Conclusions: AERD patients have a differential baseline inflammatory pattern that supports the role inflammation as underlying mechanism of the disease. Systemic response to oral aspirin challenge was related to an increase in serum IL-6 and the number of circulating memory T-cells in AERD patients. (C) 2015 Elsevier Ltd. All rights reserved.Flemish Research Board (FWO) [FWO08-PDO-117]Flemish Scientific Research Board (FWO) [A12/5-HB-KH3, 1841713N, G039412N]Interuniversity Attraction Poles (IAP) Project [P7/30]Jagiellonian University [K/ZDS/000362][Pezato, RogerioHoltappels, GabrieleDe Ruyck, NatalieDerycke, LaraVan Crombruggen, KoenBachert, ClausPerez-Novo, Claudina A.] Ghent Univ Hosp, Dept Otorhinolaryngol, Upper Airways Res Lab, Ghent, Belgium[Pezato, Rogerio] Univ Fed Sao Paulo, Dept Otorhinolaryngol Head & Neck Surg, Sao Paulo, Brazil[Swierczynska-Krepa, Monika] Medex, Out Patient Allergy Clin, Bielsko Biala, Poland[Niankowska-Mogilnicka, EwaSanak, Marek] Jagiellonian Univ, Sch Med, Dept Med, Krakow, PolandDept. of Otorhinolaryngology, Head and Neck Surgery, Federal University of São Paulo, São Paulo, BrazilThis work was supported by a grant to Dr. Claudina Perez-Novo from the Flemish Research Board (FWO Post-doctoral mandate, Nr. FWO08-PDO-117), grants to Prof. Claus Bachert from the Flemish Scientific Research Board (FWO Nr. A12/5-HB-KH3, FWO mandate: 1841713N and FWO research project: G039412N), the Interuniversity Attraction Poles (IAP) Project P7/30 and the statutory grant from the Jagiellonian University (K/ZDS/000362) awarded to Dr. Monika Swierczynska-Krepa.Web of Scienc