Nasal provocation tests with lysine aspirin

Provocation tests with aspirin reliably prove aspirin hypersensitivity in patients with a history of prior reaction to non-steroidal anti-inflammatory drugs. The nasal provocation test with lysine-aspirin was introduced into clinical practice in the late 1980s. It is a valuable screening test in patients with aspirin hypersensitivity restricted to the upper airway and in those with severe asthma in whom oral and bronchial aspirin challenges are contraindicated. Nasal challenge with lysine-aspirin is relatively simple, cheap and quite easy to be supervised in a hospital outpatient clinic. A positive nasal reaction is defined as the appearance of clinical symptoms such as rhinorrhoea, sneezing and nasal congestion combined with significant decreases in some parameters of rhinomanometry, acoustic rhinometry and/or peak inspiratory flows. However, a negative nasal challenge should be followed by the oral aspirin test. The detailed protocol of the nasal provocation test with lysine-aspirin is presented in this article.