Xiao Hao, Xu Feng, Jia Qiaoru, Zhang Li, Shi Chuqi, Du Jintao, Yang Hui, Meng Juan
Allergy Center, West China Hospital, Sichuan University, Chengdu, China; Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
J Allergy Clin Immunol Pract. 2025 Jul;13(7):1732-1738. doi: 10.1016/j.jaip.2025.03.038. Epub 2025 Apr 3.
Aspirin-exacerbated respiratory disease (AERD) is a chronic eosinophilic inflammatory disorder characterized by asthma, chronic rhinosinusitis with nasal polyps, and intolerance to cyclooxygenase-1 inhibitors. Intranasal aspirin challenge (IAC) is increasingly used for AERD diagnosis owing to its practicality and safety. However, the lack of standardized symptom score criteria and an optimal dosage complicates its diagnostic utility.
To establish symptom score criteria and determine the optimal cumulative dosage for IAC in diagnosing AERD.
A total of 116 patients with chronic rhinosinusitis with nasal polyps were enrolled, including 58 with AERD and 58 without it. Group A (n = 70, 35 AERD and 35 non-AERD) was used to establish the symptom score criteria, which were validated in group B (n = 46, 23 AERD and 23 non-AERD). Symptom severity was assessed using a visual analog scale (VAS), and diagnostic accuracy was evaluated using receiver operating characteristic curve analysis. The safety and optimal dosage of IAC were also investigated.
The optimal cutoff value for the increase in total VAS (T-VAS) was 7.5 points, with a sensitivity of 80.0% and specificity of 97.1%. A maximal cumulative dosage of 70 mg achieved the highest diagnostic accuracy (91.3%) and sensitivity (87.0%). Nasal congestion and rhinorrhea were the most pronounced symptoms during IAC in patients with AERD. The IAC was generally well tolerated, and 4.3% of participants experienced acute worsening of asthma.
This study identifies a T-VAS increase of 7.5 points and a maximal cumulative dosage of 70 mg as optimal for diagnosing AERD via IAC, providing a reliable, safe, and practical diagnostic approach.
阿司匹林诱发的呼吸道疾病（AERD）是一种慢性嗜酸性粒细胞炎症性疾病，其特征为哮喘、伴有鼻息肉的慢性鼻窦炎以及对环氧化酶-1抑制剂不耐受。鼻内阿司匹林激发试验（IAC）因其实用性和安全性，在AERD诊断中越来越常用。然而，缺乏标准化的症状评分标准和最佳剂量使其诊断效用复杂化。
建立症状评分标准并确定IAC诊断AERD的最佳累积剂量。
共纳入116例伴有鼻息肉的慢性鼻窦炎患者，其中58例患有AERD，58例未患AERD。A组（n = 70，35例AERD和35例非AERD）用于建立症状评分标准，并在B组（n = 46，23例AERD和23例非AERD）中进行验证。使用视觉模拟量表（VAS）评估症状严重程度，并通过受试者操作特征曲线分析评估诊断准确性。还研究了IAC的安全性和最佳剂量。
总VAS（T-VAS）增加的最佳截断值为7.5分，敏感性为80.0%，特异性为97.1%。最大累积剂量70 mg时诊断准确性最高（91.3%），敏感性最高（87.0%）。鼻塞和流涕是AERD患者IAC期间最明显的症状。IAC总体耐受性良好，4.3%的参与者哮喘急性加重。
本研究确定T-VAS增加7.5分和最大累积剂量70 mg是通过IAC诊断AERD的最佳标准，提供了一种可靠、安全且实用的诊断方法。
