Wismol P, Putivoranat P, Buranapraditkun S, Pinnobphun P, Ruxrungtham K, Klaewsongkram J
Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Allergol Immunopathol (Madr). 2012 May-Jun;40(3):156-63. doi: 10.1016/j.aller.2010.12.011. Epub 2011 Apr 13.
The oral provocation test (OPT) is the current gold standard to diagnose aspirin hypersensitivity syndrome although it is time-consuming and contains some systemic risks. Other reliable methods with lower side effects and shorter test duration are being investigated.
The purpose of this study was to evaluate the efficacy of the nasal provocation test (NPT) and the basophil activation test (BAT) in the diagnosis of different subtypes of aspirin sensitivity.
Thirty aspirin sensitivity patients with cutaneous and respiratory manifestations underwent NPT and BAT with lysine-ASA. NPT result was interpreted as recommended in EAACI/GA2LEN guidelines and receiver operating characteristic analysis of BAT was performed by using 15 NSAIDs tolerant volunteers as a control group.
NPT was positive in 60% (18/30) of patients and BAT was positive in 76.7% (23/30) of patients. The incubation of basophils with 0.31 mg/ml of lysine-aspirin and using 4.6% activated basophils gives the best predictive values to diagnose aspirin sensitivity. The combination of both tests yielded positive results in 80% and 93.3% of aspirin-induced cutaneous and respiratory patterns. The agreement between NPT and BAT results was 63.3%.
NPT and BAT are beneficial to detect patients with aspirin sensitivity. The combination of both tests have additional diagnostic values; less time-consuming than OPT and their complications are negligible. A reliable alternative method with minimum side effects is needed to diagnose aspirin sensitivity in suspected patients who have contraindications for OPT.
口服激发试验（OPT）是目前诊断阿司匹林超敏反应综合征的金标准，尽管该试验耗时且存在一些全身风险。目前正在研究其他副作用较小、测试时间较短的可靠方法。
本研究旨在评估鼻激发试验（NPT）和嗜碱性粒细胞活化试验（BAT）在诊断不同亚型阿司匹林敏感性方面的疗效。
30例有皮肤和呼吸道表现的阿司匹林敏感患者接受了赖氨酸-ASA的NPT和BAT。NPT结果按照欧洲变态反应和临床免疫学会/欧洲临床营养与代谢学会（EAACI/GA2LEN）指南的建议进行解读，并以15名非甾体抗炎药耐受志愿者作为对照组进行BAT的受试者工作特征分析。
60%（18/30）的患者NPT呈阳性，76.7%（23/30）的患者BAT呈阳性。嗜碱性粒细胞与0.31mg/ml赖氨酸-阿司匹林孵育，并以4.6%的活化嗜碱性粒细胞作为诊断阿司匹林敏感性的最佳预测值。两种试验联合在80%和93.3%的阿司匹林诱发的皮肤和呼吸道模式中产生阳性结果。NPT和BAT结果之间的一致性为63.3%。
NPT和BAT有助于检测阿司匹林敏感患者。两种试验联合具有额外的诊断价值；比OPT耗时少，且其并发症可忽略不计。对于有OPT禁忌证的疑似患者，需要一种副作用最小的可靠替代方法来诊断阿司匹林敏感性。
