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Review
. 2025 May;155(5):1411-1419.
doi: 10.1016/j.jaci.2025.03.006. Epub 2025 Mar 18.

Clinical and mechanistic advancements in aspirin exacerbated respiratory disease

Shabnam Elahi  1 , Anju T Peters  1 , Atsushi Kato  1 , Whitney W Stevens  2
Affiliations
Review

Clinical and mechanistic advancements in aspirin exacerbated respiratory disease

Shabnam Elahi et al. J Allergy Clin Immunol. 2025 May.

Abstract

Aspirin-exacerbated respiratory disease (AERD) is characterized by the clinical triad of chronic rhinosinusitis with nasal polyps, asthma, and a hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). AERD is estimated to occur in as many as 15% of patients with chronic rhinosinusitis with nasal polyps and/or asthma. Uniquely, patients with AERD develop respiratory symptoms within 30 to 180 minutes after ingesting NSAIDs such as aspirin or ibuprofen. However, even in the absence of NSAIDs, patients tend to have more severe upper and lower respiratory disease. The underlying pathogenic mechanisms contributing to AERD are complex and intertwined; they include a systemic dysregulation in arachidonic acid metabolism, an aberrant inflammatory response, a disruption in the respiratory epithelial barrier, and an imbalance between the formation and degradation of fibrin locally in nasal polyps. This review will highlight novel mechanistic findings contributing to the pathogenesis of AERD. In addition, recent advancements in the clinical understanding and management of patients with AERD will be discussed.

Keywords: AERD; NSAID-ERD; biologics; biologics. CRSwNP; mechanisms; nasal polyps; natural history; treatment.

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Conflict of interest statement

Disclosure statement Supported by the National Institutes of Health (grants K23AI141694 and P01AI141694), the Walder Foundation/Doris Duke Foundation, and the Ernest Bazley Trust. Disclosure of potential conflict of interest: A. T. Peters reports research support from AstraZeneca, SanofiRegeneron and is a consultant for AstraZeneca, Sanofi Regeneron, GSK, Eli Lilly, Chiesi and Novartis. A. Kato has served on an advisory board for AstraZeneca and received research grants from Regeneron and AstraZeneca. W. W. Stevens has served on advisory boards for Regeneron, GlaxoSmithKline, and Melinta Therapeutics. The remaining author declares that she has no relevant conflicts of interest.

References

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