Aspirin-exacerbated respiratory disease: Prevalence, diagnosis, treatment, and considerations for the future

Abstract

Aspirin-exacerbated respiratory disease (AERD) is a late onset condition characterized by the Samter triad (aspirin sensitivity [as well as sensitivity to any nonselective cyclooxygenase inhibitor], nasal polyps, asthma) and additional features, including eosinophilic chronic rhinosinusitis, hypereosinophilia, anosmia, frequent absence of atopy, and, intolerance to ingestion of red wine and other alcoholic beverages. The diagnosis is rare, and, because of this, it is also often missed by physicians. However, it is highly overexpressed in patients with severe asthma (and severe chronic rhinosinusitis with nasal polyps), which makes its recognition essential. For this review, we considered mechanisms involved in the pathogenesis of this disease and discussed the clinical symptoms of AERD. We also discussed the role of aspirin desensitization in the treatment of AERD. Also, we considered medications (e.g, leukotriene modifiers) and surgical interventions that have a role in the treatment of AERD.

Figure 1.

Double-blind placebo-controlled trial of aspirin desensitization in patients with aspirin-exacerbated respiratory disease (AERD). Analysis of the data supported significant improvements in forced expiratory volume in 1 second (FEV₁) (A), 22-item Sino-Nasal Outcome Test (SNOT-22) scores (B), symptom scores (C), and medication scores (D). (E) Further, there is evidence of improved computed tomography scores at 6 months (Lund-Mackay) (from Ref. 57) (republished with permission).