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Criteria for respiratory reactions during oral challenge with aspirin

ASA-induced:	Events during reaction:
Rhinitis, conjunctivitis, and bronchospasm (classic reaction)	Naso-ocular reaction and >15% decline in FEV₁ compared with patient's baseline
Bronchospasm alone (lower respiratory)	No naso-ocular reaction, but >20% decline in FEV₁ compared with patient's baseline
Rhinitis and conjunctivitis (upper respiratory)	Naso-ocular reactions and <15% decline in FEV₁ compared with patient's baseline
Laryngeal spasm	Crowing sounds over trachea with an amputated inspiratory loop in the flow/volume curve
Systemic response	Gastrointestinal pain, flushing, urticaria, and rarely, hypotension
Negative	No reaction

Patients with AERD are usually premedicated with leukotriene-modifying agents prior to challenge. In the absence of this premedication, a spectrum of reactions to aspirin challenge are observed. With premedication, the changes in FEV₁ are dramatically reduced and/or eliminated, while nasal and ocular symptoms remain.

ASA: aspirin; FEV₁: forced expiratory volume in one second; AERD: aspirin-exacerbated respiratory disease.

Reproduced with permission from: Stevenson DD, Simon RA, Zuraw BL. Sensitivity to aspirin and nonsteroidal antiinflammatory drugs. In: Middleton's Allergy: Principles and Practice, 6th Ed, Adkinson NF, Yunginger JW, Busse WW, et al (Eds), Mosby, St. Louis, MO 2003. p.1695. Copyright © 2003 Elsevier.

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