BMJ  2004;328:434 (21 February), doi:10.1136/bmj.328.7437.434

Paper

Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice

¹ Woolcock Institute of Medical Research, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia, ² King's College Hospital, London SE5 9RS, ³ Asthma Centre, Royal Prince Alfred Hospital

Objective To reassess the prevalence of aspirin induced asthma and other issues related to the syndrome.

Data sources Biosis, SciSearch (1990 to March 2002), Embase (1974 to March 2002), Medline (1966 to March 2002), Toxline, Derwent Drug File (1964 to March 2002), Conference Papers Index and Inside Conferences, Int'l Pharmaceutical Abstracts, Pharma-Online (1978 to March 2002).

Selection criteria Study type, patient population, and outcome measures. Review was restricted to respiratory responses to analgesics available without prescription.

Results The prevalence of aspirin induced asthma was highest when determined by oral provocation testing (adults 21%, 95% confidence interval 14% to 29%; children 5%, 0% to 14%) than by verbal history (adults 3%, 2% to 4%; children 2%, 1% to 3%). Cross sensitivity to doses of over the counter non-steroidal anti-inflammatory drugs was present in most patients with aspirin induced asthma: ibuprofen, 98%; naproxen, 100%; and diclofenac, 93%. The incidence of cross sensitivity to paracetamol among such patients was only 7%.

Conclusions Aspirin induced asthma in adults is more prevalent than previously suggested. When there is a clinical necessity to use aspirin or a non-steroidal anti-inflammatory drug and there is uncertainty about safety, oral provocation testing should be performed.

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