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©2013 UpToDate ® Print Email Protocols for aspirin challenge to detect respiratory reactions induced by NSAIDs Aspirin doses, mg Time Day 1* Day 2 Day 3 Oral challenge protocol performed for patient management and based upon commercially available aspirin tablets 8 am 40.5• 325 (Done) 11 am 81 2 pm 162 Alternate protocol performed for research purposes 8 am Placebo* 40.5• 325 (Done) 11 am Placebo 81 2 pm Placebo 162 For either protocol, begin only if baseline forced expiratory volume in 1 second (FEV1) is 70 percent or greater than patient's best, without bronchodilator. Alternatively, if the absolute FEV1 value is greater than 1.5 L and represents the best prior FEV1 value, proceed with oral challenge. Patients are expected to develop some signs and symptoms in response to ASA during the challenge procedure. This confirms the diagnosis of a pseudoallergic NSAID reaction. When this protocol is used to desensitize a patient to aspirin, the provoking dose is repeated once symptoms have been treated and subsided, 3 hours after the previous dose. Most patients will have minimal or no symptoms to the repeated dose, but the dose should be repeated until the patient no longer reacts. The protocol then procedes to completion. Most patients will not have additional symptoms. * Placebos are essential in research protocols, but are usually not needed when the challenge is performed for the sole purpose of patient management. On the placebo day, FEV1 values should vary by <10 percent from baseline, and starting FEV1 value on day 2 should be within 10 percent of the starting value on day 1. • Dose obtained by cutting an 81 mg tablet with a pill cutter. A lower starting dose of 20 mg is suggested for patients who are not taking a leukotriene modifying drug, have a baseline FEV1 of <80 percent of predicted, or who have a history of emergency department visits for acute asthma. First protocol from: Macy, E, Bernstein, JA, Castells, MC, et al. Aspirin challenge and desensitization for aspirin-exacerbated respiratory disease: a practice paper. Ann Allergy Asthma Immunol 2007; 98:172. Alternate protocol modified 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.