Nasal polyposis is a risk factor for having positive lysine-aspirin nasal challenges in aspirin-exacerbated respiratory disease

Aspirin-exacerbated respiratory disease (AERD) is a disorder of polyposis, rhinitis, asthma, and respiratory reactions to non-steroidal anti-inflammatory drugs (NSAIDs). The diagnosis is based on the clinical history and NSAIDs challenge, being nasal provocation test with lysine-aspirin (NPT-LASA) a safer and less time-consuming alternative than oral challenge. Our aim was to evaluate the potential factors related to positive results in NPT-LASA. We performed NPT-LASA in 57 confirmed AERD subjects (≥3 episodes of respiratory manifestations with ≥3 different NSAIDs or positive oral challenge with ASA). We also included 30 tolerant individuals to NSAIDs. We analyzed age, gender, underlying diseases, number of episodes, NSAIDs-induced symptoms, time interval of drug intake-reaction onset and last reaction-study in both negative and positive NPT-LASA cases. From 57 confirmed AERD subjects with a mean of 42.5 (25.75-55.25) years 73.7% were female. The 70.4% had underlying rhinitis, 63% asthma and 30.2% polyposis. The 66% were atopic and 66.7% non-smoker. The 52.7% experienced asthma after NSAIDs intake, 30.9% rhinitis/asthma, 5.4% throat tightness/asthma and 3.64% rhinitis and/or throat tightness. NPT-LASA was positive in 45 patients and negative in all controls (sensitivity: 78.94%; specificity: 100%). The percentage of patients with nasal polyposis was higher in the group with NPT-LASA positive compared to those negative (50% vs 11.1% p=0.002, OR=8(1.923-33.274), p=0.004). NPT-LASA shows a high sensitivity and specificity for diagnosing AERD, being the risk of having a positive NPT-LASA 8 times higher in patient with nasal polyposis.