Nasal ketorolac and oral aspirin challenge^[1]

Time administered (hours from start)	Intranasal ketorolac (sprays) or aspirin (mg) dose
Day 1
0	1 spray (1.26 mg)
0.5	2 sprays (1 per nostril)
1	4 sprays (2 per nostril)
1.5	6 sprays (3 per nostril)
2.5	40.5 mg aspirin orally
4	81 mg aspirin
7	Done. Patient is discharged until the next day.
Day 2
0	162 mg
3	325 mg
6	Desensitization complete.

To prepare and administer ketorolac nasal spray*:

Mix ketorolac tromethamine (60 mg/2 mL) + preservative-free normal saline (2.75 mL).
Pour into empty nasal spray bottle from pharmacy^¶
Prime by dispensing 5 sprays into the air before initial use, then each spray will dispense 1.26 mg of solution.
Instruct patient to tilt head down while spraying and sniff gently (to avoid having solution drain down the throat).

* This procedure cannot be performed if the patient has complete nasal obstruction.
¶ A bottle of commercial nasal corticosteroid spray can be emptied and washed out for this purpose. Most bottles are designed to deliver between 50 and 140 mcL (volume per actuation can be obtained from the manufacturer). An administered volume of 100 mcL is optimal in adults. Higher volumes tend to drip out of the nostrils. Bottles can be washed and reused as long as possible. The applicator tip can be cleaned with an alcohol swab between sprays and patients. Absolute sterility is not required because the nostrils are not sterile.

Reference:

Lee RU, White AA, Ding D, et al. Use of intranasal ketorolac and modified oral aspirin challenge for desensitization of aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 2010; 105:130.

Graphic 131911 Version 1.0

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Nasal ketorolac and oral aspirin challenge[1]

Nasal ketorolac and oral aspirin challenge^[1]