Drug provocation test
DPTs were performed in a single blind manner [9, 12-14, 24]: placebo
capsules were given at different times on the first day; and increasing
doses of NSAIDs were administered orally on the second/third days. The
two/three test days were separated by at least 1 week. Drugs and placebo
were given in opaque capsules prepared by the hospital pharmacy service.
DPT to ASA was performed in patients reporting less than 3 episodes
induced by less than 3 different NSAIDs in order to classify them into
CRs (they reacted to ASA) or SRs (they tolerated ASA) (Figure 1)
[10]. For DPT, two doses of ASA were administered orally (50 and 100
mg) with an interval of 180 minutes on the 2nd day test. If negative,
other two doses of ASA (250 and 500 mg) were administered on the 3rd
day, also with a 180-minute interval.
In addition to ASA, DPT to the culprit AP was performed in subjects who
tolerated ASA if they reported less than 2 episodes induced by APs
[10, 18]. If they reacted, they were classified into SRs, whereas if
they tolerated the culprit APs, they were confirmed as non-allergic
(Figure 1) [10]. Drugs were given in increasing doses every 90
minutes: 5, 50,100, 200, and 250 mg for ibuprofen (accumulative dose 600
mg); 3.125, 3.125, 6.25, and 12.5 for dexketoprofen (accumulative dose
25 mg); 5, 10, and 50 mg in the second day and 50, 100, 100, 250 mg
(accumulative dose 500 mg) in the third day for naproxen; and 5, 10, 10,
and 25 mg for ketoprofen (accumulative dose 50 mg).
If cutaneous and/or respiratory symptoms or alterations in vital signs
appeared, the procedure was stopped and the symptoms were evaluated and
treated. If no symptoms appeared during DPT and the therapeutic dose was
achieved, a 2-day/8-hour course of the therapeutic dose after a gap of
24 hours was performed [13].
Before beginning the DPT procedure, patients were stable and their
forced expiratory volume in 1s had to be at least 80% of the predicted
value, with an absolute volume of at least 1.5 L. Medications were
stopped before DPT according to international guidelines [9, 12-14,
24].