What is aspirin-exacerbated respiratory disease (AERD)?

November, 16th, 2023

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Aspirin-exacerbated respiratory disease (AERD), also called Samter’s triad, has three features:

• Asthma, although only a small number of people with asthma will develop AERD.
• Nasal polyps that often come back, even after taken out by surgery.
• Problems with taking aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) and naproxen. Keep in mind that aspirin or NSAIDs may be in cold medicines and other medicines.

Usually, warning signs of AERD don’t show up until people have reached their 30s or 40s, but AERD can sometimes happen in children.

What happens when people with AERD take aspirin or NSAIDs?

Problems usually start suddenly and can be serious. Symptoms may include trouble breathing, which could be an asthma flare-up, wheezing, coughing, sneezing, and a stuffy or runny nose. Some people with AERD also have these types of problems if they drink alcohol, such as beer or wine.

What causes AERD?

The exact cause of AERD is not known but it is not an allergic response. There is no proof to show that it’s genetic or inherited. The disease is not caused by taking aspirin or NSAIDs, but AERD sinus or asthma symptoms get worse when taking these medicines.

How is AERD found?

There is no special test to find AERD. There are lab tests that can help in finding the cause of your illness. There is a blood test to look for higher than usual levels of white blood cells called eosinophils. And there is a urine test to look for raised leukotrienes, which are chemicals that can cause tightening of the airways. AERD also may affect your sense of smell. Finding AERD is possible if you have all three of these things: asthma, nasal polyps, and respiratory problems when taking aspirin or NSAIDs.

When it’s not clear whether you have a problem taking aspirin or NSAIDs, your health care provider may do an aspirin challenge called desensitization. This is done to check if you have AERD. Your provider and medical team give you aspirin in a safe medical surrounding and follow special safety rules.

How is AERD treated? Is there a cure?

There is no cure for AERD, but several treatments can be given, depending on your illness. A blend of treatments often work best. Choices are:

• Stay away from aspirin and NSAIDs, unless your health care provider prescribes desensitization to aspirin.
• Taking medicines to treat asthma, such as corticosteroids that you breathe in.
• Surgery to remove nasal polyps, although they can come back.
• Taking medicines such as montelukast (Singulair, zafirlukast (Accolate) or zileuton (Zyflo) to block leukotrienes.
• Injecting man-made proteins into your body that connect to certain targets. These proteins, called monoclonal antibodies, try to affect cells that are causing your problem.
• Having desensitization to aspirin. Aspirin is given in the health care provider’s office in slowly increasing doses over two days. After that, it is taken daily at high doses, which may help lessen the need for oral steroids. It also may stop nasal polyps from coming back.