engleski

Prolonged asthmatic response after aspirin bronchial challenge: a case report

Background Acetylsalicylic acid (ASA) sensitivity appears as the &#8220; aspirin triad&#8221; : chronic rhinosinusitis with nasal polyposis, asthma, and intolerance to ASA. Challenge tests (oral, bronchial or nasal) are considered to be only reliable confirmation of the diagnosis. Bronchial challenge is considered to induce mild reactions. We present a patient who was hospitalized due to severe, prolonged asthmatic response after bronchial aspirin challenge. Methods Bronchial provocation test was done by the method of Bianco and coworkers. Intermittent inhalations of increasing doses of aspirin-lysine solution were applied until a significant fall in FEV1 from the basal value was obtained. Peripheral blood eosinophil counts and nasal smears for cytological analyses were performed before and after the challenge. Production of leukotrienes was tested by Cellular antigen stimulation test (CAST ELISA). Case picture A 72-year-old male Caucasian, firstly presented with rhinitis and nasal polyposis, developed first asthma attack after second polypectomy. Asthma was of moderate grade, controlled with topical steroids and long acting beta2-agonists. Total serum IgE was 1348.80 kU/L (normal range <122). Skin prick test to aeroallergens was negative. The diagnosis of aspirin sensitivity was suspected, and aspirin bronchial challenge was performed. Thirty-five minutes after inhalation of 90 mg/ml aspirin-lysine solution, 25% fall in FEV1 accompanied with nasal obstruction and secretion developed. Systemic and topical steroids and bronchodilators were applied. In spite of the therapy, bronchospasm persisted for five days. Morning FEV1 for next five days was as follows: 48%, 52%, 54%, 52%, and 82%. Blood eosinophil count recorded before challenge was 0.011 x109/L, and increased to 0.233 x109/L 60 minutes after challenge. Eosinophils in nasal smear before challenge were not found, but 60 minutes after challenge their percentage raised to 43% of total leukocyte number. CAST ELISA assay was negative prior and 10 minutes post challenge. Conclusion Although bronchial challenge with aspirin is considered a safe procedure, more severe bronchial reactions are possible. We presented a patient who developed severe asthma attack which persisted for 5 days. Pathophysiology of such prolonged asthmatic response after single trigger is not clear. In this case, overproduction of leukotrienes due to alterations in arachidonic acid metabolism could not be confirmed by CAST ELISA.

asthma; aspirin; bronchial challenge

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